Provider Demographics
NPI:1184933129
Name:MANHEIM, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MANHEIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BROADWAY
Mailing Address - Street 2:#12D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:718-234-2145
Mailing Address - Fax:
Practice Address - Street 1:176 BROADWAY
Practice Address - Street 2:#12D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2511
Practice Address - Country:US
Practice Address - Phone:718-234-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical