MEDICARE: DR. ZAIN MANJI DDS, MD

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	60-262981	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	50-055838	NY

General Provider Information

NPI Number	:	1609034685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAIN MANJI DDS, MD

Provider Business Mailing Address
First Line	:	4705 CENTER BLVD
Second Line	:	#2607
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5740
Country	:	US
Telephone Number	:	917-455-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 CENTER BLVD
Second Line	:	#2607
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5740
Country	:	US
Telephone Number	:	917-455-1598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	10/31/2011

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