Provider Demographics
NPI:1013922335
Name:KUMAR, MANOJ (MD)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:KUMAR
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 1:64 POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2708
Mailing Address - Country:US
Mailing Address - Phone:607-753-6560
Mailing Address - Fax:607-753-6757
Practice Address - Street 1:64 POMEROY ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2708
Practice Address - Country:US
Practice Address - Phone:607-753-6560
Practice Address - Fax:607-753-6757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241226207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02806619Medicaid
NYI60175Medicare UPIN