Individual
MANUEL MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 BARD AVE, STATEN ISLAND, NY 10310
(718) 818-1234
Mailing address
3733 RICHMOND AVE, STATEN ISLAND, NY 10312
(718) 948-6177
(718) 948-8189
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
237891
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02694700
—
NY
Enumeration date
06/23/2006
Last updated
07/08/2007
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