Healthcare Provider Details

I. General information

NPI: 1386169100
Provider Name (Legal Business Name): MANI KATANOV MSED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24902 JERICHO TPKE STE 207
FLORAL PARK NY
11001-4000
US

IV. Provider business mailing address

24902 JERICHO TPKE STE 207
FLORAL PARK NY
11001-4000
US

V. Phone/Fax

Practice location:
  • Phone: 718-635-2404
  • Fax:
Mailing address:
  • Phone: 718-635-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: