Provider Demographics
NPI:1053710913
Name:MANTHURUTHIL, SACHIN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:SACHIN
Middle Name:JOSEPH
Last Name:MANTHURUTHIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 SENECA RD N
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9684
Mailing Address - Country:US
Mailing Address - Phone:937-414-2287
Mailing Address - Fax:
Practice Address - Street 1:7329 SENECA RD N
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843
Practice Address - Country:US
Practice Address - Phone:607-247-2361
Practice Address - Fax:607-385-3679
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-17
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298984207RC0200X
NY298984-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine