Provider Demographics
NPI:1427124155
Name:THAKKER, PROMILA MANUAL (MD)
Entity type:Individual
Prefix:MRS
First Name:PROMILA
Middle Name:MANUAL
Last Name:THAKKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 YALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-626-2580
Mailing Address - Fax:
Practice Address - Street 1:177 LIVINGSTON ST LOWR LEVEL
Practice Address - Street 2:HEARTSHARE WELLNESS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7000
Practice Address - Country:US
Practice Address - Phone:718-855-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1279612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237430Medicaid
P00305593OtherRAILROAD MEDICARE
B12593Medicare UPIN
P00305593OtherRAILROAD MEDICARE
NY00237430Medicaid