Active NPI
Tara Manny, PA
- Physician Assistant
- Queensbury, NY
National Provider Identifier
1760858534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 018734
- Practice address
- 25 Willowbrook Rd Ste 2
Queensbury, NY 12804-3137 - Phone
- (518) 793-9156
- Fax
- (518) 793-6591
- NPI assigned
- Aug 17, 2015
- Last updated
- Jun 11, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 018734 | NY | Primary |
Addresses
Primary practice location
25 Willowbrook Rd Ste 2
Queensbury, NY 12804-3137
Mailing address
25 Willowbrook Rd Ste 2
Queensbury, NY 12804-3137
Phone (518) 793-9156
Other practice location 1
211 Church St
Saratoga Springs, NY 12866
Phone (518) 587-1141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04351997 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018734 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saratoga Regional Medical , P.C | Past | Accepting new patients |
Interoperability endpoints
- tmanny26905@albanymed.direct-ci.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Nephrology Physician
- Glens Falls, NY
- NPI 1982094827
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1760858534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 WILLOWBROOK RD STE 2",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128043137",
"telephone_number": "518-793-9156",
"fax_number": "518-793-6591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 WILLOWBROOK RD STE 2",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128043137",
"telephone_number": "518-793-9156",
"fax_number": "518-793-6591"
}
],
"practiceLocations": [
{
"address_1": "211 Church St",
"address_purpose": "LOCATION",
"city": "Saratoga Springs",
"state": "NY",
"postal_code": "12866",
"country_code": "US",
"telephone_number": "518-587-1141",
"fax_number": "518-587-1152",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MANNY",
"first_name": "TARA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-17",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "018734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04351997",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Queensbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.