Provider Demographics
NPI:1285665430
Name:MANI, PUSHPA (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
Middle Name:
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SAND PIT RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5927
Mailing Address - Country:US
Mailing Address - Phone:203-791-9599
Mailing Address - Fax:203-791-8100
Practice Address - Street 1:16 HOSPITAL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5927
Practice Address - Country:US
Practice Address - Phone:203-791-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032144208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001321447Medicaid
CTOTH000Medicare UPIN
CT001321447Medicare UPIN