1124051313 NPI number — NIELS MANU DUA MD

Table of content: NIELS MANU DUA MD (NPI 1124051313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124051313 NPI number — NIELS MANU DUA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUA
Provider First Name:
NIELS
Provider Middle Name:
MANU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124051313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/19/2006
NPI Reactivation Date:
09/07/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3274 STEINWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11103-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-997-4957
Provider Business Mailing Address Fax Number:
718-721-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3274 STEINWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-997-4957
Provider Business Practice Location Address Fax Number:
718-721-0122
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  211446 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02602308 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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