Provider Demographics
NPI:1083194351
Name:MANHATTAN INTEGRATIVE GASTROENTEROLOGY
Entity Type:Organization
Organization Name:MANHATTAN INTEGRATIVE GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSTINA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-634-4233
Mailing Address - Street 1:928 BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8149
Mailing Address - Country:US
Mailing Address - Phone:212-634-4233
Mailing Address - Fax:
Practice Address - Street 1:550 VANDERBILT AVE APT 803
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:917-825-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255074207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty