Provider Demographics
NPI:1659141679
Name:MEDICAL SERVICES OF MANHASSET, PC
Entity Type:Organization
Organization Name:MEDICAL SERVICES OF MANHASSET, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-623-7100
Mailing Address - Street 1:25 SMITH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2971
Mailing Address - Country:US
Mailing Address - Phone:845-623-7100
Mailing Address - Fax:845-732-8440
Practice Address - Street 1:25 SMITH ST STE 210
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2971
Practice Address - Country:US
Practice Address - Phone:845-623-7100
Practice Address - Fax:845-732-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty