MEDICARE: MANHATTAN OB/GYN SURGICAL SUITES

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	207L00000X	Anesthesiology Physician
2	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1689021529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANHATTAN OB/GYN SURGICAL SUITES

Provider Business Mailing Address
First Line	:	86 BROADWAY
Second Line	:	P.O. BOX 8052
City	:	WOODCLIFF LAKE
State	:	NJ
Zip	:	07677
Country	:	US
Telephone Number	:	404-661-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 DEKALB AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5311
Country	:	US
Telephone Number	:	212-308-4988
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RONALD DAVID BLATT
Credential	:	M.D.
Telephone Number	:	917-658-6443

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	08/30/2024

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