Provider Demographics
NPI:1508017062
Name:MANANA PETROV PRIMARY MEDICAL CARE, PC
Entity Type:Organization
Organization Name:MANANA PETROV PRIMARY MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-850-6345
Mailing Address - Street 1:353 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1308
Mailing Address - Country:US
Mailing Address - Phone:718-940-2100
Mailing Address - Fax:718-940-2100
Practice Address - Street 1:353 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1308
Practice Address - Country:US
Practice Address - Phone:718-850-6345
Practice Address - Fax:718-559-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty