Ayesha Mannan, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

308856 Issued in NY

Practice address

515 Broadway
Massapequa, NY 11758-5005

Phone

(631) 667-0388

Fax

(631) 968-7705

NPI assigned

Apr 23, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

New York College of Osteo Medicine of New York Institute of Technology, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Long Island Comprehensive Medical Care PLLCGroup PAC ID 3678731908, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ayesha.mannan@lcmc.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Long Island Comprehensive Medical Care PLLC

  • Internal Medicine Physician
  • North Babylon, NY
  • NPI 1043588536
  Medicare reassignment Care Compare group
• Shahzad Iqbal Physician PLLC

  • Gastroenterology Physician
  • Queens Village, NY
  • NPI 1316331168
  NPD (past)

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1497243703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927",
            "fax_number": "631-376-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585005",
            "telephone_number": "631-667-0388",
            "fax_number": "631-968-7705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1231 Deer Park Ave",
            "address_purpose": "LOCATION",
            "city": "North Babylon",
            "state": "NY",
            "postal_code": "117033104",
            "country_code": "US",
            "telephone_number": "631-667-0388",
            "fax_number": "631-968-7705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANNAN",
        "first_name": "AYESHA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "308856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Marie Maltby
• Athena Mamane, LPN
• Ashley Mancilla, FNP-BC
• Diana M Manfre
• Samantha Mann, DPT
• Nicholas Manos, D.D.S.
• Emily Marie Maracic
• Carline Marcelin
• Christine Beatrice Marchena
• Nicholas A Marchese, DPM

• Family Medicine Physician in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.