Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Manuel Licitra Fajardo, MD

Individual provider Internal Medicine Physician · NPI 1831461417

Dr. Manuel Licitra Fajardo, MD is an Internal Medicine in Garden City, New York. Qualified in 2011, 15 years ago. Practices with Mount Sinai School of Medicine, a 151-clinician group and accepts Medicare assignment. Licensed in Connecticut and New York.

Years since qualifying
15
Licensed in
CT, NY
In the registry since
2012
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

100 Somerset Ave Garden City
Garden City, NY 11530-1231
Phone: (516) 741-4898
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 279410 (NY)
Internal Medicine Physician Taxonomy 207R00000X · Licence 53519 (CT)
Hospitalist Physician Taxonomy 208M00000X · Licence 53519 (CT)
Hospitalist Physician Taxonomy 208M00000X · Licence 279410 (NY)

Record details

NPI number1831461417
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJanuary 30, 2012
Last updated in NPPESJanuary 23, 2024
Certification dateJanuary 23, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Mount Sinai School Of Medicine — 151 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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