Provider Demographics
NPI:1750615381
Name:EAST MANHATTAN MEDICAL SERVICES,PC
Entity type:Organization
Organization Name:EAST MANHATTAN MEDICAL SERVICES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-845-9255
Mailing Address - Street 1:3 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0459
Mailing Address - Country:US
Mailing Address - Phone:212-845-9255
Mailing Address - Fax:
Practice Address - Street 1:3 E 83RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0459
Practice Address - Country:US
Practice Address - Phone:212-845-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198210-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA40003375Medicare PIN
NYA400033071Medicare PIN
NYA100024648Medicare PIN