=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447642871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHATTAN BEHAVIORAL MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2015
-----------------------------------------------------
Last Update Date | 02/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 E 50TH ST SUITE 2A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-7752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-678-4196
-----------------------------------------------------
Fax | 646-850-6164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 E 50TH ST SUITE 2A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-7752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-678-4196
-----------------------------------------------------
Fax | 646-850-6164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JUDITH FIONA JOSEPH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 908-500-0185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------