Healthcare Provider Details

I. General information

NPI: 1831360577
Provider Name (Legal Business Name): MANISHA RELAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SOUTHWOODS BLVD
ALBANY NY
12211-2554
US

IV. Provider business mailing address

18 OAKHURST CT
MOUNT SINAI NY
11766-3422
US

V. Phone/Fax

Practice location:
  • Phone: 518-434-1446
  • Fax:
Mailing address:
  • Phone: 248-470-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number260649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: