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NPI Code Detail

MEDICARE: ABDUL MANNAN DO

MEDICARE: ABDUL MANNAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist Physician339159NY
2207R00000XInternal Medicine Physician339159NY

General Provider Information

NPI Number : 1245971498
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDUL MANNAN DO
Provider Business Mailing Address
First Line : 100 KINGS HWY S
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-5504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1455 E RIDGE RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-2006
Country : US
Telephone Number : 585-922-4101
Fax Number : 585-922-5822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2022
Last Update Date : 03/30/2026

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