Fairy Laine Espina Manzano

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

406726 Issued in NY

Practice address

20 Exeter Ave
Lynbrook, NY 11563-3710

Phone

(347) 351-2454

NPI assigned

Jun 9, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Interborough Developmental and Consultation Center IncGroup PAC ID 7911898192, 167 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Interborough Developmental and Consultation Center, Inc.

  dba LSA Recovery

  • Case Management Agency
  • Brooklyn, NY
  • NPI 1588611842
  Medicare reassignment Care Compare group NPD
• Interborough Developmental and Consultation Center, Inc.

  dba IDCC Health Services

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1912867433
  NPD

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744502400000",
    "number": "1417572173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E 125TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100356000",
            "telephone_number": "646-766-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 EXETER AVE",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115633710",
            "telephone_number": "347-351-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANO",
        "first_name": "FAIRY LAINE",
        "middle_name": "ESPINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2025-04-13",
        "certification_date": "2025-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NY",
            "license": "730040",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "406726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Efraim Malayev, PHARMD
• Patricia Mangi, RN
• Deborah Jill Mann, PSY.D.
• Doris Mann, LCSW
• Robin Manza, LMHC
• Map Ny Consulting, Inc
• Shaira Maqsudi
• Mala Anne Maranzano
• Howard Jay Margolin, O.D.
• Kaleigh A Marino, RPA-C

• Psychiatric/Mental Health Nurse Practitioner in Lynbrook, NY
• Providers in Lynbrook, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.