Provider Demographics
NPI:1760681142
Name:MANSUKHANI, STELLA MARIA P (MD)
Entity Type:Individual
Prefix:MS
First Name:STELLA MARIA
Middle Name:P
Last Name:MANSUKHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6102
Mailing Address - Country:US
Mailing Address - Phone:212-740-7400
Mailing Address - Fax:212-740-7408
Practice Address - Street 1:111 WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6102
Practice Address - Country:US
Practice Address - Phone:212-740-7400
Practice Address - Fax:212-740-7408
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02891490Medicaid
NYA300018389Medicare PIN