MEDICARE: MEDICAL GROUP OF MANHATTAN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1073552469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL GROUP OF MANHATTAN, PC

Provider Business Mailing Address
First Line	:	108 E 96TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6217
Country	:	US
Telephone Number	:	212-410-6610
Fax Number	:	212-348-0749

Provider Business Practice Location Address
First Line	:	108 E 96TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6217
Country	:	US
Telephone Number	:	212-410-6610
Fax Number	:	212-348-0749

Authorized Official
Title or Position	:	PARTNER
Name	:	VICKI LOPACHIN
Credential	:	MD
Telephone Number	:	212-410-6610

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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