Provider Demographics
NPI:1760544837
Name:EASTSIDE GYNECOLOGY SERVICES
Entity Type:Organization
Organization Name:EASTSIDE GYNECOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-782-6485
Mailing Address - Street 1:144 E 44TH ST
Mailing Address - Street 2:SUITE# 225
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4008
Mailing Address - Country:US
Mailing Address - Phone:212-308-4988
Mailing Address - Fax:212-308-2221
Practice Address - Street 1:144 E 44TH ST
Practice Address - Street 2:SUITE# 225
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4008
Practice Address - Country:US
Practice Address - Phone:212-308-4988
Practice Address - Fax:212-308-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty