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General NPI Number Information
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NPI Number | 1598004582
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Entity Type | Individual
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Provider Name | MANOJ MODI RPA-C,MPAS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 2001 MARCUS AVE STE W170
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-2042
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Country | US
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Telephone | 516-355-0111
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Fax | 516-355-9420
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Provider Business Mailing Address
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Address Line | 1012 N ONTARIO AVE
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City | LINDENHURST
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State | NY
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Zip | 11757-2222
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Country | US
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Telephone | 917-306-5532
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 016323
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License Number State | NY
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