Provider Demographics
NPI:1851595102
Name:MANHATTAN GRAND OPTICAL CORP
Entity Type:Organization
Organization Name:MANHATTAN GRAND OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTABET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-219-8896
Mailing Address - Street 1:203 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3739
Mailing Address - Country:US
Mailing Address - Phone:212-219-8896
Mailing Address - Fax:212-219-1263
Practice Address - Street 1:203 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3739
Practice Address - Country:US
Practice Address - Phone:212-219-8896
Practice Address - Fax:212-219-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4070305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service