Provider Demographics
NPI:1699470153
Name:LUCIAN MIRON MANU MD PSYCHIATRY PC
Entity type:Organization
Organization Name:LUCIAN MIRON MANU MD PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCIAN
Authorized Official - Middle Name:MIRON
Authorized Official - Last Name:MANU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-601-5139
Mailing Address - Street 1:101 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1968
Mailing Address - Country:US
Mailing Address - Phone:631-601-5139
Mailing Address - Fax:
Practice Address - Street 1:190 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2905
Practice Address - Country:US
Practice Address - Phone:631-601-5139
Practice Address - Fax:631-350-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty