Organization
STATEN ISLAND PULMONARY ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE J MANIATIS M.D. (PRESIDENT)
(718) 980-5700
Entity
Organization
Contact information
Practice address
501 SEAVIEW AVE, SUITE 102, STATEN ISLAND, NY 10305-3400
(718) 980-5700
(781) 980-5499
Mailing address
501 SEAVIEW AVE, SUITE 102, STATEN ISLAND, NY 10305-3400
(718) 980-5700
(781) 980-5499
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
107251
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W07191
MEDICARE GROUP
NY
Enumeration date
05/24/2007
Last updated
07/09/2013
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