Provider Demographics
NPI:1376996470
Name:MANN, MANPREET (NP)
Entity type:Individual
Prefix:
First Name:MANPREET
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8027 BROADWAY UNIT 800114
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11380-3109
Mailing Address - Country:US
Mailing Address - Phone:347-762-6315
Mailing Address - Fax:
Practice Address - Street 1:8027 BROADWAY UNIT 800114
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11380-3109
Practice Address - Country:US
Practice Address - Phone:347-762-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405550363LP0808X
UT10132363LP0808X
NY307778363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health