=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538210588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANISH LADANI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 E 52ND ST SUITE 2C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-476-5370
-----------------------------------------------------
Fax | 646-476-5371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 RICHARDS ROAD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-986-5170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0484051
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 048405-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------