Provider Demographics
NPI:1245493774
Name:HILLSIDE FOCUS CARE INC
Entity type:Organization
Organization Name:HILLSIDE FOCUS CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:I
Authorized Official - Last Name:EZEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-206-3915
Mailing Address - Street 1:17006 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4547
Mailing Address - Country:US
Mailing Address - Phone:718-206-3915
Mailing Address - Fax:718-206-9076
Practice Address - Street 1:17006 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4547
Practice Address - Country:US
Practice Address - Phone:718-206-3915
Practice Address - Fax:718-206-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01522696Medicaid