=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427005776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE JOAN MANOV MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5599 N DIXIE HWY
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-229-7659
-----------------------------------------------------
Fax | 954-229-7744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9653 PARKVIEW AVE
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-470-0296
-----------------------------------------------------
Fax | 561-451-4563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | ME68309
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------