Provider Demographics
NPI:1972661627
Name:FAMILY MEDICAL GROUP OF MANHATTAN PC
Entity Type:Organization
Organization Name:FAMILY MEDICAL GROUP OF MANHATTAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:LEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-366-9112
Mailing Address - Street 1:22 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6842
Mailing Address - Country:US
Mailing Address - Phone:212-366-9112
Mailing Address - Fax:212-206-7719
Practice Address - Street 1:22 W 15TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6842
Practice Address - Country:US
Practice Address - Phone:212-366-9112
Practice Address - Fax:212-206-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH59331Medicare ID - Type UnspecifiedDR. MOITRI C. SAVARD
NYC06871Medicare UPIN
NYGL081A8110Medicare ID - Type UnspecifiedDR. GARY LEEDS
NYB19422Medicare UPIN
NYH59331Medicare UPIN
NYRG022A2310Medicare ID - Type UnspecifiedDR. RICHARD GOLDBERG