Provider Demographics
NPI:1508400813
Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity Type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CREDENTIALING & ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:516-453-0435
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:1143 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0440
Practice Address - Country:US
Practice Address - Phone:646-350-4815
Practice Address - Fax:646-863-6149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care