Provider Demographics
NPI:1639388960
Name:WESTSIDE MEDICAL
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-934-9720
Mailing Address - Street 1:2610 E 18TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3622
Mailing Address - Country:US
Mailing Address - Phone:718-934-9720
Mailing Address - Fax:718-616-0544
Practice Address - Street 1:137 W 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6403
Practice Address - Country:US
Practice Address - Phone:212-749-7400
Practice Address - Fax:718-616-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28F791Medicare ID - Type Unspecified
NYW1L031Medicare ID - Type Unspecified