Provider Demographics
NPI:1982988903
Name:BROADWAY MANHATTAN MEDICAL OFFICE, PC
Entity Type:Organization
Organization Name:BROADWAY MANHATTAN MEDICAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MURUGA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-543-2500
Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:STE 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3119
Mailing Address - Country:US
Mailing Address - Phone:212-543-2500
Mailing Address - Fax:212-543-2503
Practice Address - Street 1:4915 BROADWAY
Practice Address - Street 2:STE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3119
Practice Address - Country:US
Practice Address - Phone:212-543-2500
Practice Address - Fax:212-543-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty