Provider Demographics
NPI:1689714990
Name:GOPINATHAN, MANJU (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MANJU
Middle Name:
Last Name:GOPINATHAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 1ST AVE
Mailing Address - Street 2:APT # 16 M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3700
Mailing Address - Country:US
Mailing Address - Phone:212-689-7873
Mailing Address - Fax:212-685-4507
Practice Address - Street 1:1530 UNIONPORT RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7801
Practice Address - Country:US
Practice Address - Phone:212-980-1408
Practice Address - Fax:212-685-4507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052430-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics