Provider Demographics
NPI:1013106574
Name:UPPER EAST SIDE SURGICAL, PLLC
Entity type:Organization
Organization Name:UPPER EAST SIDE SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-876-7000
Mailing Address - Street 1:62 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1170
Mailing Address - Country:US
Mailing Address - Phone:212-876-7000
Mailing Address - Fax:212-876-5116
Practice Address - Street 1:62 E 88TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1170
Practice Address - Country:US
Practice Address - Phone:212-876-7000
Practice Address - Fax:212-876-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1822261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical