Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 214512 | NY |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 214512 | NY |
NPI | 1013042944 |
---|---|
Provider Name | Manish B Undavia |
First Address | Rockville Centre, NY 11570-5254 |
Second Address | Rockville Centre, NY 11570-5254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 07/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BU6441505 | DEA (01) | NY |