Provider Demographics
NPI:1538414982
Name:KUMAR, MANISH (MD)
Entity type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WILTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3829
Mailing Address - Country:US
Mailing Address - Phone:718-470-0126
Mailing Address - Fax:718-470-0128
Practice Address - Street 1:25012 HILLSIDE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2100
Practice Address - Country:US
Practice Address - Phone:718-470-0126
Practice Address - Fax:718-470-0128
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine