Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 312066-01 | NY |
NPI | 1003312323 |
---|---|
Provider Name | Manish Kumar |
First Address | Medford, NY 11763-1907 |
Second Address | Oceanside, NY 11572-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 21/09/2021 |