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General NPI Number Information
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NPI Number | 1669006946
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Entity Type | Organization
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Legal Business Name | MANHATTAN WEST SIDE MEDICAL SERVICE PLLC
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 300 FORT WASHINGTON AVE OFC 1
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City | NEW YORK
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State | NY
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Zip | 10032-1323
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Country | US
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Telephone | 212-316-3276
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Fax | 212-568-3688
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Provider Business Mailing Address
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Address Line | 300 FORT WASHINGTON AVE OFC 1
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City | NEW YORK
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State | NY
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Zip | 10032-1323
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Country | US
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Telephone | 212-316-3276
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Fax | 212-568-3688
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Authorized Official
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Title or Position | MD
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Name | RICARDO E POU
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Credential | MD
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Telephone | 212-316-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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