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General NPI Number Information
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NPI Number | 1376542217
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Entity Type | Individual
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Provider Name | JACK MICHAEL MANN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 42-23 FRANCIS LEWIS BLVD. STE. 105
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-225-5106
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Fax | 718-225-0816
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Provider Business Mailing Address
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Address Line | 42-23 FRANCIS LEWIS BLVD. STE. 105
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-225-5106
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Fax | 718-225-0816
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 158742
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License Number State | NY
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