Provider Demographics
NPI:1225188568
Name:WESTSIDE CARDIOLOGY PC
Entity Type:Organization
Organization Name:WESTSIDE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-765-0765
Mailing Address - Street 1:142 W 57TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3300
Mailing Address - Country:US
Mailing Address - Phone:212-765-0765
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:142 W 57TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3300
Practice Address - Country:US
Practice Address - Phone:212-765-0765
Practice Address - Fax:212-247-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEV041Medicare PIN