Provider Demographics
NPI:1134410590
Name:MANAQIB, MOIZ ISMAIL (MD)
Entity type:Individual
Prefix:
First Name:MOIZ
Middle Name:ISMAIL
Last Name:MANAQIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOIZ
Other - Middle Name:ISMAIL
Other - Last Name:MANAQIBWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1101 STEWART AVENUE
Mailing Address - Street 2:SUITE 100 NORTH
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-302-8180
Mailing Address - Fax:516-992-4637
Practice Address - Street 1:1101 STEWART AVENUE
Practice Address - Street 2:SUITE 100 NORTH
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-302-8180
Practice Address - Fax:516-992-4637
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277219207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03986183Medicaid
NYA400125919Medicare PIN