Provider Demographics
NPI:1669405817
Name:MANHATTAN CARDIAC PET IMAGING.PLLC.
Entity type:Organization
Organization Name:MANHATTAN CARDIAC PET IMAGING.PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN TOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-420-2092
Mailing Address - Street 1:3457 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1069
Mailing Address - Country:US
Mailing Address - Phone:716-773-8939
Mailing Address - Fax:
Practice Address - Street 1:16 FIRST AVENUE @ 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142209207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00978730Medicaid
NY00978730Medicaid
NY33D651Medicare ID - Type Unspecified