Provider Demographics
NPI:1235199266
Name:MANZOOR, SIKANDER (MD)
Entity Type:Individual
Prefix:
First Name:SIKANDER
Middle Name:
Last Name:MANZOOR
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 1:12102 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1812
Mailing Address - Country:US
Mailing Address - Phone:718-850-1673
Mailing Address - Fax:718-849-5133
Practice Address - Street 1:12102 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1812
Practice Address - Country:US
Practice Address - Phone:718-850-1673
Practice Address - Fax:718-849-5133
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867578Medicaid