Provider Demographics
NPI:1194278093
Name:MANHATTAN ORTHOPEDIC & SPORTS MEDICINE GROUP, P.C
Entity type:Organization
Organization Name:MANHATTAN ORTHOPEDIC & SPORTS MEDICINE GROUP, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-289-0700
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-289-0700
Mailing Address - Fax:212-289-0171
Practice Address - Street 1:2731 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-4293
Practice Address - Country:US
Practice Address - Phone:718-204-0548
Practice Address - Fax:718-204-4928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANHATTAN ORTHOPEDIC & SPORTS MEDICINE GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW00321Medicare PIN