Provider Demographics
NPI:1831137298
Name:CEYLONY, MANJU V (MD)
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:V
Last Name:CEYLONY
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 1:100 HIGH ST
Mailing Address - Street 2:MDC CLINIC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1126
Mailing Address - Country:US
Mailing Address - Phone:716-859-2589
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:MDC CLINIC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020553001OtherEXCELLUS UNIVERA
NY02058386Medicaid
NY0410968OtherINDEPENDENT HEALTH
NY02058386Medicaid
NYRB2582Medicare PIN