Provider Demographics
NPI:1073552469
Name:MEDICAL GROUP OF MANHATTAN, PC
Entity Type:Organization
Organization Name:MEDICAL GROUP OF MANHATTAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-410-6610
Mailing Address - Street 1:108 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6217
Mailing Address - Country:US
Mailing Address - Phone:212-410-6610
Mailing Address - Fax:212-348-0749
Practice Address - Street 1:108 E 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6217
Practice Address - Country:US
Practice Address - Phone:212-410-6610
Practice Address - Fax:212-348-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG37445Medicare UPIN
NYG89221Medicare UPIN