MEDICARE: DR. MANOJ KANTU M.D.

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	174400000X	Specialist	208745	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	159164	OTHER	NY	ELDERPLAN
2	001971490	OTHER	NY	UHC
3	20874501	OTHER	NY	NEIGHBORHOOD
4	294498	OTHER	NY	WELLCARE
5	328990101	OTHER	NY	HEALTHPLUS
6	00Z6110	OTHER	NY	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	113515454	OTHER	NY	1199
9	2227732	OTHER	NY	USHC
10	7058737	OTHER	NY	AETNAPPO
11	P2010895	OTHER	NY	OXFORD
12	010232901	OTHER	NY	AMERICHOICE
13	010232902	OTHER	NY	BAYRIDGEAMERICHOICE
14	9602037	OTHER	NY	GHIPPO
15	3877816	OTHER	NY	AETNAHMO
16	3C2434	OTHER	NY	HEALTHNET

General Provider Information

NPI Number	:	1679617971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANOJ KANTU M.D.

Provider Business Mailing Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-2500
Fax Number	:	718-648-4583

Provider Business Practice Location Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-2500
Fax Number	:	718-648-4583

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	10/02/2012

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