Healthcare Provider Details

I. General information

NPI: 1609259902
Provider Name (Legal Business Name): MANHATTAN ALLERGY, IMMUNOLOGY & RHEUMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E 77TH ST STE 201
NEW YORK NY
10075-1730
US

IV. Provider business mailing address

350 E 82ND ST APT. 11C
NEW YORK NY
10028-4909
US

V. Phone/Fax

Practice location:
  • Phone: 646-688-3443
  • Fax: 646-688-4332
Mailing address:
  • Phone: 212-988-4334
  • Fax: 212-988-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number226767
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226767
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number226767
License Number StateNY

VIII. Authorized Official

Name: DR. OLGA BELOSTOTSKY
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 917-573-3225