Individual
DR. MANOJ JACOB MAMMEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 ELMWOOD AVE., ROCHESTER, NY 14642-0001
(585) 275-4161
(585) 273-1171
Mailing address
601 ELMWOOD AVE BOX 675, ROCHESTER, NY 14642-0001
(585) 275-4161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M6273
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
257591
NY
207RP1001X
Pulmonary Disease Physician
Primary
257591
NY
363A00000X
Physician Assistant
257591
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03251714
—
NY
Enumeration date
09/10/2007
Last updated
07/17/2023
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