Basic Information
| Provider Information | |||||||||
| NPI: | 1295498988 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITY MEDICAL OF UPPER EAST SIDE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164530435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5626 MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113854736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185719714 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | KANTOR | ||||||||
| AuthorizedOfficialFirstName: | ILANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5164530435 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CITY MEDICAL OF UPPER EAST SIDE, PLLC | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.