Provider Demographics
NPI:1942579685
Name:M MICHAEL MD PC
Entity Type:Organization
Organization Name:M MICHAEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOUCHEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-567-6400
Mailing Address - Street 1:37 NAGLE AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1422
Mailing Address - Country:US
Mailing Address - Phone:212-567-6400
Mailing Address - Fax:212-567-6424
Practice Address - Street 1:37 NAGLE AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1422
Practice Address - Country:US
Practice Address - Phone:212-567-6400
Practice Address - Fax:212-567-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty