Provider Demographics
NPI:1689604712
Name:JELVEH, MANSOOR (MD)
Entity Type:Individual
Prefix:
First Name:MANSOOR
Middle Name:
Last Name:JELVEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4942
Mailing Address - Country:US
Mailing Address - Phone:516-935-8877
Mailing Address - Fax:516-935-8826
Practice Address - Street 1:875 OLD COUNTRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4942
Practice Address - Country:US
Practice Address - Phone:516-935-8877
Practice Address - Fax:516-935-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128926207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110037592OtherMC RR
NYB15194Medicare UPIN
NY48D831Medicare PIN