1003154295 NPI number — COLUMBIA EAST SIDE AMBULATORY SURGERY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003154295 NPI number — COLUMBIA EAST SIDE AMBULATORY SURGERY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA EAST SIDE AMBULATORY SURGERY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003154295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 EAST 77TH STREET
Provider Second Line Business Mailing Address:
#1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-988-0463
Provider Business Mailing Address Fax Number:
212-988-0527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 EAST 77TH STREET
Provider Second Line Business Practice Location Address:
#1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-988-0463
Provider Business Practice Location Address Fax Number:
212-988-0527
Provider Enumeration Date:
01/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ANTELL
Authorized Official First Name:
DARRICK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
212-988-0463

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  161860 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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