Provider Demographics
NPI:1588034565
Name:MANHATTAN PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:MANHATTAN PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG-ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-966-3585
Mailing Address - Street 1:217 GRAND ST
Mailing Address - Street 2:5/FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4396
Mailing Address - Country:US
Mailing Address - Phone:212-966-3585
Mailing Address - Fax:212-966-5530
Practice Address - Street 1:8031 BROADWAY
Practice Address - Street 2:LL#1
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3160
Practice Address - Country:US
Practice Address - Phone:718-565-0688
Practice Address - Fax:718-565-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03481683Medicaid