Provider Demographics
NPI:1467557801
Name:DEY, MANJUSHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJUSHREE
Middle Name:
Last Name:DEY
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 1:734 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5213
Mailing Address - Country:US
Mailing Address - Phone:716-433-1977
Mailing Address - Fax:716-433-1978
Practice Address - Street 1:734 DAVISON ROAD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5213
Practice Address - Country:US
Practice Address - Phone:716-433-1977
Practice Address - Fax:716-433-1978
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1599951208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB71089Medicare UPIN