Provider Demographics
NPI:1356335244
Name:MANETTO HILL MRI ASSOC,LLP
Entity type:Organization
Organization Name:MANETTO HILL MRI ASSOC,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-822-3666
Mailing Address - Street 1:146 MANETTO HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1324
Mailing Address - Country:US
Mailing Address - Phone:516-822-3666
Mailing Address - Fax:516-822-8428
Practice Address - Street 1:146 MANETTO HILL RD
Practice Address - Street 2:140
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1324
Practice Address - Country:US
Practice Address - Phone:516-822-3666
Practice Address - Fax:516-822-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101823-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB15838Medicare UPIN
NYB80597Medicare UPIN
NY97A101Medicare ID - Type UnspecifiedDR.JAMES T.WALKER(PIN)
NY516391Medicare ID - Type UnspecifiedDR.PAUL M.GRAPPELL(PIN)
WOD311Medicare PIN