Provider Demographics
NPI:1447475967
Name:KANITKAR, MANALI (DMD)
Entity type:Individual
Prefix:
First Name:MANALI
Middle Name:
Last Name:KANITKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 55TH ST
Mailing Address - Street 2:APT 11 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8316
Mailing Address - Country:US
Mailing Address - Phone:954-559-2553
Mailing Address - Fax:
Practice Address - Street 1:333 E 55TH ST
Practice Address - Street 2:APT 11 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8316
Practice Address - Country:US
Practice Address - Phone:954-559-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 166671223P0221X
NY0516531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075955400Medicaid
NY03398029Medicaid