Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 123165 | NY |
NPI | 1194802397 |
---|---|
Provider Name | Vijay John Mani |
First Address | Brooklyn, NY 11201-6720 |
Second Address | Brooklyn, NY 11201-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO 7986 | (02) | NY |