Provider Demographics
NPI:1316934300
Name:MANU, LUCIAN MIRON (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIAN
Middle Name:MIRON
Last Name:MANU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUCIAN
Other - Middle Name:MIRON
Other - Last Name:CISMARESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:SBUH
Practice Address - Street 2:100 NICOLLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-6050
Practice Address - Fax:631-444-3773
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2048372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG48212Medicare UPIN
NY52M382Medicare ID - Type Unspecified