Healthcare Provider Details

I. General information

NPI: 1851241327
Provider Name (Legal Business Name): MANUSHAK N GEVORGYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16123 83RD ST
HOWARD BEACH NY
11414-3312
US

IV. Provider business mailing address

16123 83RD ST
HOWARD BEACH NY
11414-3312
US

V. Phone/Fax

Practice location:
  • Phone: 347-730-1068
  • Fax:
Mailing address:
  • Phone: 347-730-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: