Provider Demographics
NPI:1497130322
Name:EAST 78 STREET MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:EAST 78 STREET MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:LAUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-0229
Mailing Address - Street 1:885 PARK AVE
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0325
Mailing Address - Country:US
Mailing Address - Phone:212-535-0229
Mailing Address - Fax:212-734-3192
Practice Address - Street 1:885 PARK AVE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0325
Practice Address - Country:US
Practice Address - Phone:212-535-0229
Practice Address - Fax:212-734-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical