Provider Demographics
NPI:1669838645
Name:MANO R ZACHARIAH MD
Entity Type:Organization
Organization Name:MANO R ZACHARIAH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZACHARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-499-2007
Mailing Address - Street 1:P.O. BOX 224
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1723
Mailing Address - Country:US
Mailing Address - Phone:845-499-2007
Mailing Address - Fax:845-499-2542
Practice Address - Street 1:60 DUTCH HILL RD
Practice Address - Street 2:SUITE 12
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1723
Practice Address - Country:US
Practice Address - Phone:845-499-2007
Practice Address - Fax:845-499-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514345Medicaid
NYIA0084Medicare PIN
NYH96468Medicare UPIN