Provider Demographics
NPI:1467543462
Name:BERANBAUM, KHILNANI, NEISTADT, JACOBS, HERTZ AND SHERMAN, M.D., P.C.
Entity Type:Organization
Organization Name:BERANBAUM, KHILNANI, NEISTADT, JACOBS, HERTZ AND SHERMAN, M.D., P.C.
Other - Org Name:MANHATTAN DIAGNOSTIC RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-838-4243
Mailing Address - Street 1:400 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9314
Mailing Address - Country:US
Mailing Address - Phone:212-838-4243
Mailing Address - Fax:212-838-7370
Practice Address - Street 1:400 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9314
Practice Address - Country:US
Practice Address - Phone:212-838-4243
Practice Address - Fax:212-838-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW23211Medicare ID - Type Unspecified