Provider Demographics
NPI:1679617971
Name:KANTU, MANOJ (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:KANTU
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 1:2204 VOORHIES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2820
Mailing Address - Country:US
Mailing Address - Phone:718-646-2500
Mailing Address - Fax:718-648-4583
Practice Address - Street 1:2204 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2820
Practice Address - Country:US
Practice Address - Phone:718-646-2500
Practice Address - Fax:718-648-4583
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159164OtherELDERPLAN
NY001971490OtherUHC
NY20874501OtherNEIGHBORHOOD
NY294498OtherWELLCARE
NY328990101OtherHEALTHPLUS
NY00Z6110OtherBCBS
NY01951000Medicaid
NY113515454Other1199
NY2227732OtherUSHC
NY7058737OtherAETNAPPO
NYP2010895OtherOXFORD
NY010232901OtherAMERICHOICE
NY010232902OtherBAYRIDGEAMERICHOICE
NY9602037OtherGHIPPO
NY3877816OtherAETNAHMO
NY3C2434OtherHEALTHNET
NY010232901OtherAMERICHOICE
NY00Z6110OtherBCBS