Provider Demographics
NPI:1780895425
Name:STATEN ISLAND PULMONARY ASSOC PC
Entity type:Organization
Organization Name:STATEN ISLAND PULMONARY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANIATIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-980-5700
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3400
Mailing Address - Country:US
Mailing Address - Phone:718-980-5700
Mailing Address - Fax:781-980-5499
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3400
Practice Address - Country:US
Practice Address - Phone:718-980-5700
Practice Address - Fax:781-980-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107251207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW07191OtherMEDICARE GROUP