Provider Demographics
NPI:1497035638
Name:WOODSIDE MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:WOODSIDE MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERBAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:COCIOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-476-5859
Mailing Address - Street 1:3120 54TH ST
Mailing Address - Street 2:SUITE L2
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1530
Mailing Address - Country:US
Mailing Address - Phone:718-476-5859
Mailing Address - Fax:
Practice Address - Street 1:31-20 54TH STREET
Practice Address - Street 2:SUITE L2
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1530
Practice Address - Country:US
Practice Address - Phone:718-476-5859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA30026029Medicaid