Healthcare Provider Details

I. General information

NPI: 1255326567
Provider Name (Legal Business Name): SETH MANOACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK AVE 96
NEW YORK NY
10065-4805
US

IV. Provider business mailing address

220 MANHATTAN AVE APARTMENT 5D
NEW YORK NY
10025-2623
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-3333
  • Fax: 646-962-0330
Mailing address:
  • Phone: 917-627-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number204372-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number204372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: