Healthcare Provider Details

I. General information

NPI: 1073510681
Provider Name (Legal Business Name): MANOJ R VORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 08/24/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 N STATE ST SUITE 250
LOWVILLE NY
13367-1229
US

IV. Provider business mailing address

7785 N STATE ST STE 250
LOWVILLE NY
13367-1297
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-5488
  • Fax: 315-376-5442
Mailing address:
  • Phone: 315-376-5488
  • Fax: 315-376-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number195101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: