Provider Demographics
NPI:1942352000
Name:WESTSIDE MEDICAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-362-6468
Mailing Address - Street 1:228 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5404
Mailing Address - Country:US
Mailing Address - Phone:212-362-6468
Mailing Address - Fax:212-362-0851
Practice Address - Street 1:228 W 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5404
Practice Address - Country:US
Practice Address - Phone:212-362-6468
Practice Address - Fax:212-362-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW3Z991Medicare PIN