Provider Demographics
NPI:1124404231
Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity Type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Other - Org Name:CITY MEDICAL OF EAST 96TH
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:M/D/
Authorized Official - Phone:212-913-0128
Mailing Address - Street 1:1345 RXR PLAZA
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556
Mailing Address - Country:US
Mailing Address - Phone:516-783-4600
Mailing Address - Fax:516-783-4612
Practice Address - Street 1:1500 LEXINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11556
Practice Address - Country:US
Practice Address - Phone:516-783-4600
Practice Address - Fax:516-783-4612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care