Individual
MANASVI JAITLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 LYON PLACE, SUITE 200, OGDENSBURG, NY 13669-2590
(315) 394-7542
(866) 506-5573
Mailing address
3 LYON PLACE, SUITE 200, OGDENSBURG, NY 13669-2590
(315) 394-7542
(866) 506-5573
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
268972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02910378
—
NY
Enumeration date
07/23/2007
Last updated
10/20/2022
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