Provider Demographics
NPI:1982966693
Name:ABDELLATIF, MANAL M
Entity Type:Individual
Prefix:MS
First Name:MANAL
Middle Name:M
Last Name:ABDELLATIF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 HYLAN BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6422
Mailing Address - Country:US
Mailing Address - Phone:718-450-1550
Mailing Address - Fax:718-317-7370
Practice Address - Street 1:4533 HYLAN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6422
Practice Address - Country:US
Practice Address - Phone:718-450-1550
Practice Address - Fax:718-317-7370
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16083171M00000X
NY454774101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY454774101OtherPUBLIC SCHOOL CERTIFIED TEACHER
NY16083OtherSERVICE COORDINATOR