Healthcare Provider Details

I. General information

NPI: 1780513366
Provider Name (Legal Business Name): MANNAHATTA MEDICAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 39TH AVE APT A517
LONG ISLAND CITY NY
11101-2770
US

IV. Provider business mailing address

3002 39TH AVE APT A517
LONG ISLAND CITY NY
11101-2770
US

V. Phone/Fax

Practice location:
  • Phone: 516-547-7564
  • Fax:
Mailing address:
  • Phone: 516-547-7564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGI DINOVA
Title or Position: CEO
Credential: MD
Phone: 516-547-7564