Provider Demographics
NPI:1255641056
Name:MANHATTAN WELLNESS MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:MANHATTAN WELLNESS MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YU
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-575-8910
Mailing Address - Street 1:16 E 41ST ST
Mailing Address - Street 2:6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 W 44TH ST
Practice Address - Street 2:10 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6611
Practice Address - Country:US
Practice Address - Phone:212-575-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1023713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty