Provider Demographics
NPI:1699226647
Name:HILLSIDE PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:HILLSIDE PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-771-8473
Mailing Address - Street 1:16403 HILLSIDE AVE
Mailing Address - Street 2:#1
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4140
Mailing Address - Country:US
Mailing Address - Phone:347-771-8473
Mailing Address - Fax:
Practice Address - Street 1:16403 HILLSIDE AVE
Practice Address - Street 2:#1
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4140
Practice Address - Country:US
Practice Address - Phone:347-771-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY277919OtherLICENSE NUMBER