Provider Demographics
NPI:1073510681
Name:VORA, MANOJ R (MD)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:R
Last Name:VORA
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 1:7785 N STATE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1297
Mailing Address - Country:US
Mailing Address - Phone:315-376-5488
Mailing Address - Fax:315-376-5442
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5488
Practice Address - Fax:315-376-5442
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477150Medicaid
NYAA0835Medicare PIN
NYF75926Medicare UPIN
NY01477150Medicaid