Provider Demographics
NPI:1679858849
Name:THE EASTSIDE ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:THE EASTSIDE ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GORALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-272-8177
Mailing Address - Street 1:1301 4TH AVE NW STE 301
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9371
Mailing Address - Country:US
Mailing Address - Phone:253-503-2508
Mailing Address - Fax:
Practice Address - Street 1:1301 4TH AVE NW
Practice Address - Street 2:STE 301
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-9369
Practice Address - Country:US
Practice Address - Phone:425-454-4768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical