Nicholas Manjarrez, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

159 Trout Avenue
Naval Undersea Medical Institute
Groton, CT 06349-5159

Phone

(860) 694-2876

NPI assigned

Apr 20, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1891229472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063495159",
            "telephone_number": "860-694-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 TROUT AVENUE",
            "address_2": "NAVAL UNDERSEA MEDICAL INSTITUTE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063495159",
            "telephone_number": "860-694-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANJARREZ",
        "first_name": "NICHOLAS",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-20",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine M Malcom, P.T.
• John Anthony Maldonado-Rivera
• Parris Malhoit
• Mark Mammoth
• Jane Sinclair Manaras, OTR/L
• Andre Jerome Marin, SUB IDC
• Stefanie M Marino-Goodrich, LMFT
• John Marsella
• Jennifer E Marshall, MD
• Sonya Lisa Marshall, DPM

• Independent Duty Corpsman in Groton, CT
• Providers in Groton, CT by specialty
• Independent Duty Corpsman in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.