Provider Demographics
NPI:1720055288
Name:ORJUELA, MANUELA ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUELA
Middle Name:ANITA
Last Name:ORJUELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUELA
Other - Middle Name:ANITA
Other - Last Name:ORJUELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4703
Mailing Address - Country:US
Mailing Address - Phone:212-662-1001
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-304-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1899022080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783531Medicaid
NY01783531Medicaid
531Y71Medicare ID - Type Unspecified