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
State | License ID | Taxonomies |
---|---|---|
NY | 1822 | 261QA1903X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |