Healthcare Provider Details

I. General information

NPI: 1053710913
Provider Name (Legal Business Name): SACHIN JOSEPH MANTHURUTHIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 06/30/2023
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7329 SENECA RD N
HORNELL NY
14843
US

IV. Provider business mailing address

7329 SENECA RD N
HORNELL NY
14843-9684
US

V. Phone/Fax

Practice location:
  • Phone: 607-247-2361
  • Fax: 607-385-3679
Mailing address:
  • Phone: 937-414-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number298984-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number298984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: