Healthcare Provider Details

I. General information

NPI: 1336337252
Provider Name (Legal Business Name): MANHATTAN COLORECTAL SURGEON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE SUITE 705
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE SUITE 705
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-675-2997
  • Fax:
Mailing address:
  • Phone: 212-675-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON PENZER
Title or Position: OWNER
Credential: MD
Phone: 212-675-2997