Healthcare Provider Details

I. General information

NPI: 1487396586
Provider Name (Legal Business Name): MANASA PRAKRUTHI VENKATARAMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANASA PRAKRUTHI RAMAN MD

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

V. Phone/Fax

Practice location:
  • Phone: 516-296-2830
  • Fax:
Mailing address:
  • Phone: 516-296-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA210355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: