Healthcare Provider Details

I. General information

NPI: 1760350862
Provider Name (Legal Business Name): MANISH REDDY DABBI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 VICTORY BLVD STE 301
STATEN ISLAND NY
10314-6635
US

IV. Provider business mailing address

653 NY 211 EAST
SCOTHTOWN NY
10941
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-0017
  • Fax: 718-761-0017
Mailing address:
  • Phone: 917-318-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014463
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: