Healthcare Provider Details

I. General information

NPI: 1255641056
Provider Name (Legal Business Name): MANHATTAN WELLNESS MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 44TH ST 10 FLOOR
NEW YORK NY
10036-6611
US

IV. Provider business mailing address

16 E 41ST ST 6A
NEW YORK NY
10017-6217
US

V. Phone/Fax

Practice location:
  • Phone: 212-575-8910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1023713
License Number StateNY

VIII. Authorized Official

Name: MR. YU KANEKO
Title or Position: MANAGER
Credential:
Phone: 212-575-8910