Provider Demographics
NPI:1801207998
Name:CITY MEDICAL OF UPPER EAST SIDE PLLC
Entity Type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE PLLC
Other - Org Name:CITYMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-721-5725
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 1:193 W 237TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4141
Practice Address - Country:US
Practice Address - Phone:718-303-0479
Practice Address - Fax:718-303-0480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL OF UPPER EAST SIDE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-12
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care