Provider Demographics
NPI:1184865701
Name:MANHATTAN WELLNESS MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:MANHATTAN WELLNESS MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TOMONORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-575-8910
Mailing Address - Street 1:15 W 44TH ST
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6611
Mailing Address - Country:US
Mailing Address - Phone:212-575-8910
Mailing Address - Fax:212-575-1830
Practice Address - Street 1:15 W 44TH ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6611
Practice Address - Country:US
Practice Address - Phone:212-575-8910
Practice Address - Fax:212-575-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239417207Q00000X
NY277398207Q00000X
NY2560522084P0800X
NY256704208D00000X, 208D00000X
NY031717225100000X
NY208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty