Organization
MANHATTAN GASTROENTEROLOGY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN KHODADADIAN M.D. (OWNER)
(646) 351-0911
Entity
Organization
Contact information
Practice address
55 W 17TH ST, NEW YORK, NY 10011-5513
(212) 427-8761
(212) 427-8762
Mailing address
121 W 27TH ST STE 504, NEW YORK, NY 10001-6207
(212) 427-8761
(212) 427-8762
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
244392
NY
207RG0100X
Gastroenterology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100252116
MEDICARE PTAN
NY
Enumeration date
07/19/2011
Last updated
10/20/2025
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