Provider Demographics
NPI:1528201522
Name:DR. MA'S MANHATTAN MEDICAL REHABILITATION, PC
Entity Type:Organization
Organization Name:DR. MA'S MANHATTAN MEDICAL REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-872-1745
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-872-1745
Mailing Address - Fax:212-872-1747
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:212-872-1745
Practice Address - Fax:212-872-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2269712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH78734Medicare UPIN