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General NPI Number Information
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NPI Number | 1891978409
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Entity Type | Organization
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Legal Business Name | MANHATTAN PSYCHIATRIC SERVICE PLLC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 353 FORT WASHINGTON AVENUE SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10033
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Country | US
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Telephone | 212-928-0014
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Fax | 212-928-0017
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Provider Business Mailing Address
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Address Line | 353 FORT WASHINGTON AVENUE SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10033
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Country | US
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Telephone | 212-928-0014
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Fax | 212-928-0017
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. CHRISTIAN RENE GONZALEZ
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Credential | MD
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Telephone | 212-928-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 213498
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License Number State | NY
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