Provider Demographics
NPI:1861552051
Name:ZACHARIAH, MANO RAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:MANO
Middle Name:RAJAN
Last Name:ZACHARIAH
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:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1723
Mailing Address - Country:US
Mailing Address - Phone:845-499-2007
Mailing Address - Fax:845-499-2542
Practice Address - Street 1:60 DUTCH HILL RD
Practice Address - Street 2:SUITE 12
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1723
Practice Address - Country:US
Practice Address - Phone:845-499-2007
Practice Address - Fax:845-499-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861552051OtherNPI
NY02514345Medicaid
NY02514345Medicaid
1861552051OtherNPI