1891978409 NPI number — MANHATTAN PSYCHIATRIC SERVICE PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891978409 NPI number — MANHATTAN PSYCHIATRIC SERVICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANHATTAN PSYCHIATRIC SERVICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891978409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 FORT WASHINGTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-928-0014
Provider Business Mailing Address Fax Number:
212-928-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 FORT WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-928-0014
Provider Business Practice Location Address Fax Number:
212-928-0017
Provider Enumeration Date:
12/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
212-928-0014

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  213498 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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