Google ranks local results on relevance, distance and prominence. In most of the country distance is measured in miles. In Manhattan it is measured in blocks, and there is a competitor on most of them.
That density changes the whole approach.
What density does
A searcher on 23rd Street and a searcher on 72nd Street get substantially different local results, and both are in your city. You are not competing for "med spa NYC" as a single ranking — you are competing for hundreds of micro-locations, and you will hold a few of them.
This is better news than it sounds. It means a practice with a strong profile can dominate its own neighborhood completely, which is where its realistic patients are anyway.
In New York, the achievable goal is owning your neighborhood, not the city. The neighborhood is also where your patients actually come from.
Neighborhood, not borough
Target the way New Yorkers speak. "Med spa Upper East Side," "botox Williamsburg," "filler Astoria." Borough-level terms are contested by everyone and specific to nobody.
Your location page should read as though written by someone who works there — the subway lines, the cross street, which entrance, whether there is a doorman. This is the difference between a genuine location page and a template with the place name swapped in.
Transit, not miles
Proximity in New York is functionally about transit rather than distance. A patient two miles away on the same line is closer than one half a mile away requiring a transfer.
Say the lines in your content. It is genuinely useful to the reader, it is strong local relevance, and almost no clinic does it.
Reviews in a city that reads them
New York consumers are marketed to constantly and have calibrated hard against it. Review profiles get scrutinized more than almost anywhere, and a thin one is disqualifying.
Volume, recency, and responses to everything — the mechanics are in reviews as a ranking factor. For medical practices, remember that a reply confirming someone is your patient is a disclosure problem created by the reply.
Upstate is a completely different exercise
Everything above describes downstate. In Rochester or Syracuse, proximity is measured in drive time, competition is a fraction of the city's, and a practice doing basic local SEO competently can rank city-wide — which is impossible in Manhattan at any budget.
That gap is the same one that shows up in paid, and we wrote it up in upstate versus downstate New York. If you have locations in both, they need separate strategies, separate content and separate expectations.
The compliance note
Your Google Business Profile is advertising, and New York's rules about who may own a practice and who may perform treatment apply to what it claims. A profile describing "our doctors" at a practice with one supervising physician is making the same claim a Facebook ad would — we covered that — and the profile is more publicly visible than the ad.
If your New York practice is chasing borough-level terms, moving to neighborhood terms is usually the fastest available improvement.