Healthcare Provider Details

I. General information

NPI: 1144132556
Provider Name (Legal Business Name): MANJU JOSHI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 48TH ST
SUNNYSIDE NY
11104-1646
US

IV. Provider business mailing address

4333 48TH ST APT 3I
SUNNYSIDE NY
11104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 347-393-4842
  • Fax:
Mailing address:
  • Phone: 347-393-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number755853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: