1114054558 NPI number — EAST SIDE CARDIOLOGY PLLC

Table of content: (NPI 1114054558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114054558 NPI number — EAST SIDE CARDIOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SIDE CARDIOLOGY 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:
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:
1114054558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 E 76TH ST
Provider Second Line Business Mailing Address:
SUITE C101
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-535-0106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 E 76TH ST
Provider Second Line Business Practice Location Address:
SUITE C101
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-535-0106
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONIS
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
212-531-0399

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  210657 , 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)

  • Identifier: 210657 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C5506 . This is a "ACS HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3232573 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7317425 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02379091 . This is a "MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2291730 08 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 90353 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 504P42 . This is a "EMPRE BCBS OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2804094 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0157027 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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