Individual provider Active NPI

Maria Luisa Manalo, NP

  • Acute Care Nurse Practitioner
  • New York, NY
National Provider Identifier
1053063115
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
432285 Issued in NY
Practice address
177 Fort Washington Ave
New York, NY 10032-3733
Phone
(212) 305-9564
Fax
(212) 342-3591
NPI assigned
Jan 20, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2021119042 FL
Acute Care Nurse Practitioner 363LA2100X 432285 NY Primary

Addresses

Primary practice location

177 Fort Washington Ave
New York, NY 10032-3733

Mailing address

177 Fort Washington Ave
New York, NY 10032-3733
Phone (212) 305-9564

Other practice location 1

4269 SW 121st Way Apt 302
Miramar, FL 33025-3784
Phone (310) 954-7514

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230301001397 NY Practitioner - Nurse Practitioner 1951774520 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2021119042FLMDAcute Care Nurse Practitioner
432285NYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Mar 3, 2025 Accepting new patients

Locations

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

177 Fort Washington Ave
New York, NY 10032
Phone (212) 305-3090

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: mam9787@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1053063115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323733",
            "telephone_number": "212-305-9564",
            "fax_number": "212-342-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323733",
            "telephone_number": "212-305-9564",
            "fax_number": "212-342-3591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4269 SW 121st Way Apt 302",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330253784",
            "country_code": "US",
            "telephone_number": "310-954-7514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANALO",
        "first_name": "MARIA",
        "middle_name": "LUISA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "2021119042",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "432285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.