Provider Demographics
NPI:1710370358
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:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDRYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-625-9911
Mailing Address - Street 1:100 LIVINGSTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5127
Mailing Address - Country:US
Mailing Address - Phone:718-625-9911
Mailing Address - Fax:718-625-9517
Practice Address - Street 1:100 LIVINGSTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5127
Practice Address - Country:US
Practice Address - Phone:718-625-9911
Practice Address - Fax:718-625-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty