Provider Demographics
NPI:1104806561
Name:MANARIS, ANASTASIOS (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:
Last Name:MANARIS
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 1:500 MONTAUK HWY
Mailing Address - Street 2:STE S
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4420
Mailing Address - Country:US
Mailing Address - Phone:631-940-9009
Mailing Address - Fax:631-940-9010
Practice Address - Street 1:540 UNION BLVD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3105
Practice Address - Country:US
Practice Address - Phone:631-669-2555
Practice Address - Fax:631-669-5787
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1945031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02075152Medicaid
NYH12654Medicare UPIN
NY02075152Medicaid