Provider Demographics
NPI:1922598598
Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYMENT SOLUTIONS
Authorized Official - Prefix:
Authorized Official - First Name:SWAHILI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-988-0482
Mailing Address - Street 1:1345 AVENUE OF THE AMERICAS FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10105-0018
Mailing Address - Country:US
Mailing Address - Phone:908-588-3635
Mailing Address - Fax:
Practice Address - Street 1:100 GRANNY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2873
Practice Address - Country:US
Practice Address - Phone:631-698-7828
Practice Address - Fax:631-698-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care