Healthcare Provider Details

I. General information

NPI: 1932265832
Provider Name (Legal Business Name): SANTOSH MANOHAR PARAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE SVCMC-DEPARTMENT OF PEDIATRICS
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

355 BARD AVE SVCMC-DEPARTMENT OF PEDIATRICS
STATEN ISLAND NY
10310-1664
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-4636
  • Fax: 718-818-2739
Mailing address:
  • Phone: 718-818-4636
  • Fax: 718-818-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number235320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: