=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841478450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHATTAN COMPREHENSIVE EAR MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2008
-----------------------------------------------------
Last Update Date | 06/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 MADISON AVENUE SUITE 10 SW
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-213-3456
-----------------------------------------------------
Fax | 646-695-0690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 MADISON AVENUE SUITE 10 SW
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-213-3456
-----------------------------------------------------
Fax | 646-695-0690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER 50 PERCENT
-----------------------------------------------------
Name | STACEY L SILVERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-213-3456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 232741
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 7431
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 202817
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------