Provider Demographics
NPI:1578695995
Name:JASTY & MANVAR PC
Entity Type:Organization
Organization Name:JASTY & MANVAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BUDDHADEV
Authorized Official - Middle Name:
Authorized Official - Last Name:MANVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-234-2300
Mailing Address - Street 1:6414 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3929
Mailing Address - Country:US
Mailing Address - Phone:718-234-2300
Mailing Address - Fax:718-234-0098
Practice Address - Street 1:6414 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3929
Practice Address - Country:US
Practice Address - Phone:718-234-2300
Practice Address - Fax:718-234-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215612207R00000X
NY141049207R00000X, 207RC0000X, 207UN0901X, 2086S0129X
NY139432207R00000X, 207UN0901X
NY139342207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098548Medicaid
NY00709628Medicaid
NY00579740Medicaid
NYH01350Medicare UPIN
NYB14971Medicare UPIN
NYW91741Medicare ID - Type UnspecifiedJASTY, MANVAR, ABAYEV
NY02098548Medicaid