Provider Demographics
NPI:1699922294
Name:MANHATTAN MEDICAL PRACTICE PC
Entity type:Organization
Organization Name:MANHATTAN MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-406-3069
Mailing Address - Street 1:565 PLANDOME RD # 286
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1945
Mailing Address - Country:US
Mailing Address - Phone:174-063-0699
Mailing Address - Fax:
Practice Address - Street 1:989 W JERICHO TPKE STE 1
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3241
Practice Address - Country:US
Practice Address - Phone:917-406-3069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232151207L00000X, 207RG0100X
NY142907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty