Provider Demographics
NPI:1477692556
Name:MANSUKHANI, MAHESH MOHANDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:MOHANDAS
Last Name:MANSUKHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:96 HICKS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-2123
Mailing Address - Country:US
Mailing Address - Phone:212-305-2646
Mailing Address - Fax:212-305-2301
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PATHOLOGY ADMINISTRATION PH1564W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222689207ZP0007X
NY222689-1207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG89233Medicare UPIN