Provider Information for 1922396472
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MANHATTAN GASTROENTEROLOGY P.C.
Organization Subpart: NO
NPI: 1922396472
Last Updated: 2021-03-25
Certification Date: 2021-03-25
Certification Date: 2021-03-25
Details
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| NPI | 1922396472 | ||||||||||||||||||||||||||||||||
| Enumeration Date | 2011-07-19 | ||||||||||||||||||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||||||||||
| Authorized Official Information | Name: Dr. SHAWN KHODADADIAN m.d. Title: owner Phone: 5163138642 | ||||||||||||||||||||||||||||||||
| Mailing Address | 121 W 27TH ST STE 504 NEW YORK, NY 10001-6207 United States Phone: 212-427-8761 | Fax:212-427-8762 | ||||||||||||||||||||||||||||||||
| Primary Practice Address | 55 W 17TH ST NEW YORK, NY 10011-5513 United States Phone: 212-427-8761 | Fax:212-427-8762 | ||||||||||||||||||||||||||||||||
| Secondary Practice Address(es) | 983 PARK AVE STE 1D | ||||||||||||||||||||||||||||||||
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