Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | NYS PERMIT P80993 | NY |
NPI | 1053660258 |
---|---|
Provider Name | Dr. Manjula Warad Shivputra |
First Address | Ridgewood, NY 11385 |
Second Address | Ridgewood, NY 11385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2012 |
Last Update Date | 30/09/2013 |