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FAIRY LAINE ESPINA MANZANO
NPI 1417572173
Nurse Practitioner - Psychiatric/Mental Health in Lynbrook, NY

Active since June 09, 2020PECOS Enrolled
20 EXETER AVE, LYNBROOK, NY 11563(347) 351-2454 Get Directions Write a Review

NPPES record last updated: April 13, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 13, 2025, Jun 9, 2020 (2 updates tracked since 2020).

About Fairy Laine Espina Manzano NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRY LAINE ESPINA MANZANO (NPI 1417572173) is an individual psychiatric/mental health provider in Lynbrook, New York, licensed in New York (406726) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1417572173
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameFAIRY LAINE ESPINA MANZANO
Location Address20 EXETER AVELynbrook, NY 11563-3710
Mailing Address600 E 125th StNew York, NY 10035-6000 · (646) 766-4000
Phone(347) 351-2454
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateJune 9, 2020
Last NPPES UpdateApril 13, 20252 updates tracked since enumeration
NPPES CertifiedApril 13, 2025
✔ NPI 1417572173 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in NY · 406726
Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License 730040 (NY)
20 EXETER AVE, Lynbrook, NY 11563
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Fairy Laine Espina Manzano is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234639089
PECOS Enrollment IDI20250826000370
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Fairy Laine Manzano reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Interborough Developmental And Consultation Center, Inc.
16 mi
Case Management
1623 KINGS HWY
Brooklyn, NY 11229
  • Reassigned Medicare billing, New York enrollment
  • 306 clinicians in this Medicare group
NPI 1588611842 (718) 375-1200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11563 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$117.62 typical visit price
range $21.66 – $164.45
Typical copayment $29.40 (range $5.41 – $41.11)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fairy Laine Manzano's NPI number?

The NPI number for Fairy Laine Manzano is 1417572173. It was assigned to this individual provider in the NPPES registry on June 9, 2020.

Where is Fairy Laine Manzano located?

Fairy Laine Manzano practices at 20 Exeter Ave, Lynbrook, NY 11563. The listed phone number is (347) 351-2454.

What is Fairy Laine Manzano's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Fairy Laine Manzano enrolled in Medicare?

Yes. Fairy Laine Manzano is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Fairy Laine Manzano's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Fairy Laine Manzano reassigns Medicare benefits to Interborough Developmental And Consultation Center, Inc. (Brooklyn, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Fairy Laine Manzano's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Fairy Laine Manzano was last updated on April 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.