1922556513 NPI number — CITY MEDICAL OF UPPER EAST SIDE, PLLC

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 1922556513 NPI number — CITY MEDICAL OF UPPER EAST SIDE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY MEDICAL OF UPPER EAST SIDE, PLLC
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:
6
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:
1922556513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 AVENUE OF THE AMERICAS FL 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10105-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-588-3635
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-430-5778
Provider Business Practice Location Address Fax Number:
516-430-5779
Provider Enumeration Date:
09/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
SWAHILI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PAYMENT SOLUTIONS
Authorized Official Telephone Number:
908-988-0482

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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