Provider Demographics
NPI:1609484492
Name:MANHATTAN FACIAL PLASTIC SURGERY AND EAR NOSE & THROAT PROFESSIONAL
Entity Type:Organization
Organization Name:MANHATTAN FACIAL PLASTIC SURGERY AND EAR NOSE & THROAT PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-801-1847
Mailing Address - Street 1:400 E 20TH ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8105
Mailing Address - Country:US
Mailing Address - Phone:212-381-6110
Mailing Address - Fax:212-381-6110
Practice Address - Street 1:400 EAST 20TH STREET STE 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009
Practice Address - Country:US
Practice Address - Phone:212-381-6110
Practice Address - Fax:212-381-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty