Provider Demographics
NPI:1720050701
Name:MANOLAS, PANAGIOTIS (MD)
Entity type:Individual
Prefix:
First Name:PANAGIOTIS
Middle Name:
Last Name:MANOLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 30TH DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1874
Mailing Address - Country:US
Mailing Address - Phone:718-626-0707
Mailing Address - Fax:718-545-0333
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-626-0707
Practice Address - Fax:718-545-0333
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172874208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01051445Medicaid
NY10E073Medicare PIN
NY01051445Medicaid
NY02105Medicare PIN