MEDICARE: MANHATTAN WEST SIDE MEDICAL SERVICES PLLC

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	174400000X	Specialist	192097	NY

General Provider Information

NPI Number	:	1689983215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANHATTAN WEST SIDE MEDICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-0086
Country	:	US
Telephone Number	:	212-316-3276
Fax Number	:	212-568-3688

Provider Business Practice Location Address
First Line	:	300 FT WASHINGTN AVE STE 1S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1323
Country	:	US
Telephone Number	:	212-316-3276
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICARDO E POU
Credential	:	MD
Telephone Number	:	212-316-3276

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	05/11/2020

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