Provider Demographics
NPI:1003072901
Name:MANHATTAN DERMATOLOGIC HEALTH, P.C.
Entity Type:Organization
Organization Name:MANHATTAN DERMATOLOGIC HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIROTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAOCHUMROONVORAPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-288-2536
Mailing Address - Street 1:1317 3RD AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2995
Mailing Address - Country:US
Mailing Address - Phone:212-288-2536
Mailing Address - Fax:212-288-3206
Practice Address - Street 1:1317 3RD AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2995
Practice Address - Country:US
Practice Address - Phone:212-288-2536
Practice Address - Fax:212-288-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214926207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000205Medicare PIN