Provider Demographics
NPI:1023459013
Name:EAST 57TH MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:EAST 57TH MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KICHENAMOURTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-203-8744
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-0158
Mailing Address - Country:US
Mailing Address - Phone:212-203-8744
Mailing Address - Fax:
Practice Address - Street 1:227 E 56TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3754
Practice Address - Country:US
Practice Address - Phone:212-203-8477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1833961207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty