1679617971 NPI number — DR. MANOJ KANTU M.D.

Table of content: DR. MANOJ KANTU M.D. (NPI 1679617971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679617971 NPI number — DR. MANOJ KANTU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTU
Provider First Name:
MANOJ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1679617971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2204 VOORHIES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-646-2500
Provider Business Mailing Address Fax Number:
718-648-4583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 VOORHIES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-2500
Provider Business Practice Location Address Fax Number:
718-648-4583
Provider Enumeration Date:
02/19/2007

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: 174400000X , with the licence number:  208745 , 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: 159164 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 001971490 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20874501 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 294498 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 328990101 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00Z6110 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01951000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113515454 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2227732 . This is a "USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7058737 . This is a "AETNAPPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2010895 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010232901 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010232902 . This is a "BAYRIDGEAMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9602037 . This is a "GHIPPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3877816 . This is a "AETNAHMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C2434 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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