Provider Demographics
NPI:1396720926
Name:MANAV II INC
Entity type:Organization
Organization Name:MANAV II INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANIGIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-665-6007
Mailing Address - Street 1:449 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4210
Mailing Address - Country:US
Mailing Address - Phone:212-665-6007
Mailing Address - Fax:212-665-6220
Practice Address - Street 1:449 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4210
Practice Address - Country:US
Practice Address - Phone:212-665-6007
Practice Address - Fax:212-665-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026778333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3339478OtherNCPDP
NY02590265Medicaid
NY5188010001Medicare ID - Type Unspecified