Provider Demographics
NPI:1598093494
Name:MID-MANHATTAN MEDICAL, P.C.
Entity Type:Organization
Organization Name:MID-MANHATTAN MEDICAL, P.C.
Other - Org Name:PARK AVENUE TRAUMA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:HEDRYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-472-1717
Mailing Address - Street 1:240 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5705
Mailing Address - Country:US
Mailing Address - Phone:212-472-1717
Mailing Address - Fax:212-472-6103
Practice Address - Street 1:240 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5705
Practice Address - Country:US
Practice Address - Phone:212-472-1717
Practice Address - Fax:212-472-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty