Provider Demographics
NPI:1073992574
Name:NEW YORK HEIGHTS MEDICAL PC
Entity Type:Organization
Organization Name:NEW YORK HEIGHTS MEDICAL PC
Other - Org Name:NEW HEIGHTS MEDICINE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-740-7400
Mailing Address - Street 1:111 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6102
Mailing Address - Country:US
Mailing Address - Phone:212-740-7400
Mailing Address - Fax:
Practice Address - Street 1:111 WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6102
Practice Address - Country:US
Practice Address - Phone:212-740-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty