Provider Demographics
NPI:1821665100
Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity Type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-453-0435
Mailing Address - Street 1:1345 RXR PLZ
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:
Practice Address - Street 1:260 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9196
Practice Address - Country:US
Practice Address - Phone:646-293-7500
Practice Address - Fax:646-293-7509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-07
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty