Provider Demographics
NPI:1942272547
Name:MANOUEL, MEHRAN (MD)
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:MANOUEL
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:PO BOX 230406
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-0406
Mailing Address - Country:US
Mailing Address - Phone:718-897-2228
Mailing Address - Fax:718-897-2251
Practice Address - Street 1:7655 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6948
Practice Address - Country:US
Practice Address - Phone:718-897-2228
Practice Address - Fax:718-897-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184765207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01393044Medicaid
NYF52333Medicare UPIN
NY01393044Medicaid