Vyacheslav Mamanov, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

310305 Issued in NY

Practice address

10218 64TH Ave
Forest Hills, NY 11375-1548

Phone

(646) 479-9710

NPI assigned

Aug 7, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628294400000",
    "number": "1154095677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10218 64TH AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10218 64TH AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751548",
            "telephone_number": "646-479-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMANOV",
        "first_name": "VYACHESLAV",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-07",
        "last_updated": "2021-08-07",
        "certification_date": "2021-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "310305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Malmstrom
• Anando Kumar Malo, MD
• Cassandra Theresa Malouta, MA
• Mama Program LLC
• Michelle Mamann
• Mitchell Mamorsky, D.M.D
• Gisela Mamposo, LCSW-R
• Shreya Mandal, JD LCSW
• Mollie Malka Mandel, NP
• Dominique Manfreda

• Adult Health Nurse Practitioner in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.