Provider Demographics
NPI:1932486545
Name:MANOCHA, DIVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVEY
Middle Name:
Last Name:MANOCHA
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 1:50 PRESIDENTIAL PLZ
Mailing Address - Street 2:APT 906
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2229
Mailing Address - Country:US
Mailing Address - Phone:315-200-2257
Mailing Address - Fax:
Practice Address - Street 1:105 COUNTY ROUTE 45A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6664
Practice Address - Country:US
Practice Address - Phone:315-312-0089
Practice Address - Fax:315-312-0110
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278820207RI0008X, 207RG0100X, 207R00000X, 207RG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine