Manish Soral
Individual provider Active NPI Dentist · Selden, NY
NPI 1013103159 · NPPES record last updated Sep 22, 2007
Key facts
- NPI
- 1013103159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 052795 (NY)
- Practice address
- 280 Middle Country Rd Ste K
Selden, NY 11784-2532 - Phone
- (631) 732-9000
- NPI assigned
- Sep 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052795 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coarm-Selden Dental Group | Past | Accepting new patients | |
| Coram Selden Dental Group PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 052795 | NY | Yes |
Addresses
Primary practice location
280 Middle Country Rd Ste K
Selden, NY 11784-2532
Mailing address
6 Griffin Dr
Mount Sinai, NY 11766-3108
Phone (716) 474-4728
Other providers in Selden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.