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General NPI Number Information
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NPI Number | 1982988903
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Entity Type | Organization
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Legal Business Name | BROADWAY MANHATTAN MEDICAL OFFICE, PC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 4915 BROADWAY STE 1K
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City | NEW YORK
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State | NY
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Zip | 10034-3119
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Country | US
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Telephone | 212-543-2500
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Fax | 212-543-2503
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Provider Business Mailing Address
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Address Line | 4915 BROADWAY STE 1K
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City | NEW YORK
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State | NY
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Zip | 10034-3119
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Country | US
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Telephone | 212-543-2500
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Fax | 212-543-2503
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MURUGA RAJ
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Credential | M.D
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Telephone | 212-543-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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