Provider Demographics
NPI:1336471234
Name:LUN, MANSHAN SANDRA
Entity Type:Individual
Prefix:
First Name:MANSHAN
Middle Name:SANDRA
Last Name:LUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 VAN SICKLEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3802
Mailing Address - Country:US
Mailing Address - Phone:718-373-1699
Mailing Address - Fax:
Practice Address - Street 1:1150 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2701
Practice Address - Country:US
Practice Address - Phone:212-221-3588
Practice Address - Fax:212-730-1328
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist