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Contact Information

EASTSIDE MEDICAL OFFICE , PC
58 E 116TH ST
NEW YORK, NY10029-1147
 Phone: 212-876-9700
 Fax: 212-876-5745
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Dermatology

207N00000X 07 Physician/Dermatology
 

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Nephrology

207RN0300X 11 Physician/Internal Medicine
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
Indicates primary specialty

NPI Profile & details for EASTSIDE MEDICAL OFFICE , PC

NPI # 1215095930
LBN Legal business name EASTSIDE MEDICAL OFFICE , PC
Authorized official ZAW OO - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 12/05/2006
Last updated 10/24/2014 - About 12 years ago
Identifiers
NY License # 136246
NY License # 176228
NY License # 198749
NY License # 205570
NY License # 214914
NY License # 230776
NY Medicaid 01369795
NY Medicaid 01616673
NY Medicaid 01843681
NY Medicaid 02232575
NY Medicaid 02678706
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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