Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 296525 | NY |
NPI | 1013316769 |
---|---|
Provider Name | Dr. Saravanakumar Manickam |
First Address | Sayre, PA 18840-1625 |
Second Address | Corning, NY 14830-3696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 12/03/2021 |