Provider Demographics
NPI:1528003381
Name:MANHEIMER, FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:
Last Name:MANHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:PECK SLIP STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10272-1057
Mailing Address - Country:US
Mailing Address - Phone:212-238-0189
Mailing Address - Fax:646-898-4799
Practice Address - Street 1:156 WILLIAM ST
Practice Address - Street 2:7TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2609
Practice Address - Country:US
Practice Address - Phone:212-238-0189
Practice Address - Fax:646-898-4799
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY179554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF53617Medicare UPIN
NY54H671Medicare PIN