Manhattan Medical Physician PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2327981 Issued in NY

Legal business name

MANHATTAN MEDICAL PHYSICIAN PLLC

Doing business as

Susan Park, MD

Practice address

1150 Park Ave
New York, NY 10128-1244

Phone

(212) 427-1642

Fax

(646) 351-0685

NPI assigned

Oct 21, 2010

Last updated

Oct 21, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan Park, MDNPI 1467431965

Title

Owner

Phone

(212) 427-1642

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Susan Park, MD Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Ahn Park, MD

  • Internal Medicine Physician
  • New York, NY
  • NPI 1467431965
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1780994913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101281244",
            "telephone_number": "212-427-1642",
            "fax_number": "646-351-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101281244",
            "telephone_number": "212-427-1642",
            "fax_number": "646-351-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANHATTAN MEDICAL PHYSICIAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-427-1642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "2327981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02642831",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY LICENSE",
            "identifier": "2327981",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan Park, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Manhattan Medical Suite, PC
• Manhattan Medical Supplies
• Manhattan Medical Weight Loss PC
• Manhattan Medical Wellness P.C.

• Internal Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.