Provider Demographics
NPI:1114054558
Name:EAST SIDE CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:EAST SIDE CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-531-0399
Mailing Address - Street 1:370 E 76TH ST
Mailing Address - Street 2:SUITE C101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2547
Mailing Address - Country:US
Mailing Address - Phone:212-535-0106
Mailing Address - Fax:
Practice Address - Street 1:370 E 76TH ST
Practice Address - Street 2:SUITE C101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2547
Practice Address - Country:US
Practice Address - Phone:212-535-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210657OtherHIP
NY6C5506OtherACS HEALTHNET
NY3232573OtherAETNA HMO
NY7317425OtherAETNA
NY02379091OtherMEDICAID
NY2291730 08OtherUNITED HEALTHCARE
NY90353OtherCIGNA
NY504P42OtherEMPRE BCBS OF NY
NYP2804094OtherOXFORD
NY0157027OtherGHI
NY210657OtherHIP
NY0157027OtherGHI
NYH86697Medicare UPIN