Provider Demographics
NPI:1205075587
Name:MANHATTAN MEDICAL OFFICE, P.C.
Entity type:Organization
Organization Name:MANHATTAN MEDICAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-543-2500
Mailing Address - Street 1:70 LOCUST AVE APT B103
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7375
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:SUITE 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:2009-02-11
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03304267Medicaid
NYA100035420Medicare PIN