Healthcare Provider Details

I. General information

NPI: 1649277104
Provider Name (Legal Business Name): MANHATTAN MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CENTRAL PARK S APT 107
NEW YORK NY
10019-1449
US

IV. Provider business mailing address

200 CENTRAL PARK S APT 107
NEW YORK NY
10019-1449
US

V. Phone/Fax

Practice location:
  • Phone: 212-262-2500
  • Fax: 212-246-0890
Mailing address:
  • Phone: 212-262-2500
  • Fax: 212-246-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE D. JAEGER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 212-262-2500