Mary Agnes Manor

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

1753L001 Issued in NY

Legal business name

MARY AGNES MANOR

Practice address

307 Porter Ave
Buffalo, NY 14201-1031

Phone

(716) 881-0565

NPI assigned

Sep 29, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Danny Zyskind

Title

Assistant Administrator

Phone

(716) 791-4211

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1487057972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 PORTER AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142011031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 PORTER AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142011031",
            "telephone_number": "716-881-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY AGNES MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-29",
        "last_updated": "2014-09-29",
        "status": "A",
        "authorized_official_last_name": "ZYSKIND",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "716-791-4211",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NY",
            "license": "1753L001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph D. Martino
• Carlyle Martis, M.D.
• Giulia Michela Martone, M.D.
• Ashley Elizabeth Martucci, FNP-BC, MSN
• Anuritha Reddy Marumganti, M.D.
• Jyotsna Mary George, MD
• Maryvale School System
• John M Marzo, M.D.
• Georgia Marzullo, LMSW
• Shannon D Marzullo, ANP

• Assisted Living Facility (Mental Illness) in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Assisted Living Facility (Mental Illness) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.