Basic Information
| Provider Information | |||||||||
| NPI: | 1922107697 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MANHATTAN VA HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 DONALD DR | ||||||||
| Address2: | |||||||||
| City: | HASTINGS ON HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107063621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144332792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 E 23RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100105011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIWAN | ||||||||
| AuthorizedOfficialFirstName: | ADNAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ATTENDING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9144332792 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 236586 | NY | Y | Hospitals | Military Hospital |
No ID Information.