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General NPI Number Information
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NPI Number | 1053660258
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Entity Type | Individual
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Provider Name | MANJULA WARAD SHIVPUTRA DPM
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 17-31 60TH LANE APT #311
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 347-398-7787
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Fax |
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Provider Business Mailing Address
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Address Line | 17-31 60TH LANE APT #311
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 347-398-7787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | NYS PERMIT P80993
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License Number State | NY
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