Healthcare Provider Details

I. General information

NPI: 1982966693
Provider Name (Legal Business Name): MS. MANAL M ABDELLATIF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 06/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 HYLAN BLVD 1ST FLOOR
STATEN ISLAND NY
10312-6422
US

IV. Provider business mailing address

4533 HYLAN BLVD 1ST FLOOR
STATEN ISLAND NY
10312-6422
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-1550
  • Fax: 718-317-7370
Mailing address:
  • Phone: 718-450-1550
  • Fax: 718-317-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number16083
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number454774101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: