| Doctor Name: | MS. JULIE MANIS |
| NPI Number: | 1164672564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N., GNP, PMHNP |
| License Number: | 340114 |
| Business Practice Address: | 2780 Middle Country Rd Suite 306 Lake Grove, NY - 117552124 |
| Business Phone Number: | 6319818300 |
| Business Fax Number: | 6319818400 |
| Mailing Address: | 2539 Phillip Ct, BELLMORE |
| State: | NY |
| Postal Code: | 117104931 |
| Phone Number: | 5168261654 |
| Fax Number: | |
| NPI Enumeration Date: | 09/23/2008 |
| NPI Last Update Date: | 10/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 340114 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |