Provider Demographics
NPI:1396169181
Name:BARAI, MANASVI (PA)
Entity type:Individual
Prefix:
First Name:MANASVI
Middle Name:
Last Name:BARAI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1176
Mailing Address - Country:US
Mailing Address - Phone:203-838-4000
Mailing Address - Fax:203-845-9535
Practice Address - Street 1:761 MAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-4000
Practice Address - Fax:203-845-9535
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400474344OtherMEDICARE