MEDICARE: SETH MANOACH MD

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	207P00000X	Emergency Medicine Physician	204372-1	NY
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	204372	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255326567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH MANOACH MD

Provider Business Mailing Address
First Line	:	220 MANHATTAN AVE
Second Line	:	APARTMENT 5D
City	:	NEW YORK
State	:	NY
Zip	:	10025-2623
Country	:	US
Telephone Number	:	917-627-7895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 YORK AVE
Second Line	:	96
City	:	NEW YORK
State	:	NY
Zip	:	10065-4805
Country	:	US
Telephone Number	:	646-962-3333
Fax Number	:	646-962-0330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/17/2013

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