Provider Demographics
NPI:1366686255
Name:MANVAR-SINGH, PALLAVI BUDDHADEV (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:BUDDHADEV
Last Name:MANVAR-SINGH
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 1:250 E MAIN ST
Mailing Address - Street 2:VASCULAR SURGERY
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-390-7100
Mailing Address - Fax:631-390-7128
Practice Address - Street 1:250 E MAIN ST
Practice Address - Street 2:VASCULAR SURGERY
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-390-7100
Practice Address - Fax:631-390-7128
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY274124-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty