Provider Demographics
NPI:1417168600
Name:TALREJA, MANOHAR S (BDS)
Entity Type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:S
Last Name:TALREJA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:DR
Other - First Name:MANU
Other - Middle Name:S
Other - Last Name:TALREJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS
Mailing Address - Street 1:500 5TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10110-0002
Mailing Address - Country:US
Mailing Address - Phone:212-575-7740
Mailing Address - Fax:212-575-7741
Practice Address - Street 1:500 5TH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10110-0002
Practice Address - Country:US
Practice Address - Phone:212-575-7740
Practice Address - Fax:212-575-7741
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035496-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice