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General NPI Number Information
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NPI Number | 1780895425
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND PULMONARY ASSOC PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 501 SEAVIEW AVE SUITE 102
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3400
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Country | US
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Telephone | 718-980-5700
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Fax | 781-980-5499
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Provider Business Mailing Address
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Address Line | 501 SEAVIEW AVE SUITE 102
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3400
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Country | US
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Telephone | 718-980-5700
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Fax | 781-980-5499
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE J MANIATIS
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Credential | M.D.
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Telephone | 718-980-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 107251
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License Number State | NY
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