Provider Demographics
NPI:1487669065
Name:EASTSIDE DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:EASTSIDE DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIEBESKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-751-9090
Mailing Address - Street 1:106 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8102
Mailing Address - Country:US
Mailing Address - Phone:212-751-9090
Mailing Address - Fax:212-751-9089
Practice Address - Street 1:106 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8102
Practice Address - Country:US
Practice Address - Phone:212-751-9090
Practice Address - Fax:212-751-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty