Individual
JACK MICHAEL MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
42-23 FRANCIS LEWIS BLVD., STE. 105, BAYSIDE, NY 11361
(718) 225-5106
(718) 225-0816
Mailing address
42-23 FRANCIS LEWIS BLVD., STE. 105, BAYSIDE, NY 11361
(718) 225-5106
(718) 225-0816
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
158742
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00923579
—
NY
Enumeration date
07/20/2005
Last updated
04/09/2020
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