Organization Name: | CITY MEDICAL OF UPPER EAST SIDE, PLLC |
NPI Number: | 1093131252 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD PARK (MANAGING OWNER) |
Mailing Address: | 1989 Merrick Rd Merrick |
State: | NY US |
Postal Code: | 115664643 |
Phone Number: | 5167834600 |
Fax Number: | 5167834612 |
NPI Enumeration Date: | 03/12/2014 |
NPI Last Update Date: | 06/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |