Healthcare Provider Details

I. General information

NPI: 1952639908
Provider Name (Legal Business Name): MANHATTAN COMPREHENSIVE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 PARK AVE S FLOOR 11
NEW YORK NY
10016-6822
US

IV. Provider business mailing address

PO BOX 1872
NEW YORK NY
10156-1872
US

V. Phone/Fax

Practice location:
  • Phone: 212-473-6500
  • Fax:
Mailing address:
  • Phone: 201-857-4011
  • Fax: 201-389-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number68660
License Number StateNY

VIII. Authorized Official

Name: DR. VARUZHAN DOVLATYAN
Title or Position: CEO
Credential: M.D.
Phone: 201-390-3566