Healthcare Provider Details

I. General information

NPI: 1992960728
Provider Name (Legal Business Name): MANHATTAN COLORECTAL SURGICAL UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 7TH AVE SUITE 522
NEW YORK NY
10011-6609
US

IV. Provider business mailing address

36 7TH AVE SUITE 522
NEW YORK NY
10011-6609
US

V. Phone/Fax

Practice location:
  • Phone: 212-675-2997
  • Fax: 212-627-8389
Mailing address:
  • Phone: 212-675-2997
  • Fax: 212-627-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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