Provider Demographics
NPI:1053343020
Name:MANEVITZ, DAVID DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DANIEL
Last Name:MANEVITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 YALE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2429
Mailing Address - Country:US
Mailing Address - Phone:516-801-2233
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE380
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2855
Practice Address - Country:US
Practice Address - Phone:516-759-2424
Practice Address - Fax:516-759-6627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228763208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation