1356923064 NPI number — MATEI NICHOLAS MANEA PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356923064 NPI number — MATEI NICHOLAS MANEA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANEA
Provider First Name:
MATEI
Provider Middle Name:
NICHOLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356923064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3913 NORTHWATER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARGYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76226-3882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-525-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3537 S INTERSTATE 35 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-525-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  5291 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5291 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PA16834 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 011253 . This is a "EMT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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