Healthcare Provider Details

I. General information

NPI: 1497499602
Provider Name (Legal Business Name): DR. DAVID MANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

2071 HOMECREST AVE
BROOKLYN NY
11229-2711
US

V. Phone/Fax

Practice location:
  • Phone: 594-914-4000
  • Fax:
Mailing address:
  • Phone: 646-707-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI03041400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: