Basic Information
| Provider Information | |||||||||
| NPI: | 1043815848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITY MEDICAL OF UPPER EAST SIDE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLAZA | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167834600 | ||||||||
| FaxNumber: | 5167834612 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 MAIN ST STE 16 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117436922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314237000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5167834600 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CITY MEDICAL OF UPPER EAST SIDE, PLLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.