Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 28927 | OK |
Y | 208D00000X | General Practice Physician | 051039 | CT |
NPI | 1013164854 |
---|---|
Provider Name | Nanik R Manchandani |
First Address | Brooklyn, NY 11230-1400 |
Second Address | Waterbury, CT 06705-2685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2008 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013164854 | (05) | CT |