Provider Demographics
NPI:1437187622
Name:POSITIVE HEALTH PRIMARY CARE
Entity Type:Organization
Organization Name:POSITIVE HEALTH PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-509-0943
Mailing Address - Street 1:39 5TH AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4339
Mailing Address - Country:US
Mailing Address - Phone:646-509-0943
Mailing Address - Fax:866-811-3339
Practice Address - Street 1:39 5TH AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4339
Practice Address - Country:US
Practice Address - Phone:646-509-0943
Practice Address - Fax:866-811-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02350452Medicaid
NY02350452Medicaid