Healthcare Provider Details

I. General information

NPI: 1952988149
Provider Name (Legal Business Name): RONI HADAS MANYEVITCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HUDSON AVE SURGICAL SPECIALISTS OF GLENS FALLS HOSPITAL
GLENS FALLS NY
12801
US

IV. Provider business mailing address

100 PARK STREET GLENS FALLS HOSPITAL - CREDENTIALING
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-5600
  • Fax: 518-926-5605
Mailing address:
  • Phone: 518-926-6992
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number345243
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: