Healthcare Provider Details

I. General information

NPI: 1669677423
Provider Name (Legal Business Name): MANHATTAN ORTHOPEDIC & SPORTS MEDICINE, GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WEST 57TH STREET 15TH FLOOR
NEW YORK NY
10019-2832
US

IV. Provider business mailing address

57 WEST 57TH STREET 15TH FLOOR
NEW YORK NY
10019-2832
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-0700
  • Fax: 212-289-0171
Mailing address:
  • Phone: 212-289-0700
  • Fax: 212-289-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2076931
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2035361
License Number StateNY

VIII. Authorized Official

Name: MICHELLE ROJAS
Title or Position: COO
Credential:
Phone: 212-289-0700