Provider Demographics
NPI:1366673618
Name:SURI, MANISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:SURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CARMANS RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4749
Mailing Address - Country:US
Mailing Address - Phone:516-799-5577
Mailing Address - Fax:516-799-5547
Practice Address - Street 1:25 CARMANS RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4749
Practice Address - Country:US
Practice Address - Phone:516-799-5577
Practice Address - Fax:516-799-5547
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY054438OtherNY STATE DDS