Provider Demographics
NPI:1669677423
Name:MANHATTAN ORTHOPEDIC & SPORTS MEDICINE, GROUP, P.C.
Entity Type:Organization
Organization Name:MANHATTAN ORTHOPEDIC & SPORTS MEDICINE, GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-289-0700
Mailing Address - Street 1:57 WEST 57TH STREET
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2832
Mailing Address - Country:US
Mailing Address - Phone:212-289-0700
Mailing Address - Fax:212-289-0171
Practice Address - Street 1:57 WEST 57TH STREET
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2832
Practice Address - Country:US
Practice Address - Phone:212-289-0700
Practice Address - Fax:212-289-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2076931207X00000X
NY2035361208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW00321Medicare PIN
NY7366650001Medicare PIN