Basic Information
| Provider Information | |||||||||
| NPI: | 1609842343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANASIA | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GUSTAVE L LEVY PL | ||||||||
| Address2: | BOX 1263 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122418867 | ||||||||
| FaxNumber: | 2122416238 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 EAST 98TH ST | ||||||||
| Address2: | 14TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122418867 | ||||||||
| FaxNumber: | 2122416238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 182640 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2086S0102X | 182640 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 01468060 | 05 | NY | MEDICAID |