MEDICARE: DR. MANASHEROV MEDICAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1447979513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MANASHEROV MEDICAL P.C.

Provider Business Mailing Address
First Line	:	6741 BURNS ST APT 406
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6741 BURNS ST APT 406
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3524
Country	:	US
Telephone Number	:	917-885-9906
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIKHAIL MANASHEROV
Credential	:	MD
Telephone Number	:	917-885-9906

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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