Provider Demographics
NPI:1295958841
Name:EAST SIDE GASTROENTEROLOGY, P.C.
Entity type:Organization
Organization Name:EAST SIDE GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:212-734-5533
Mailing Address - Street 1:111 E 80TH ST
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0334
Mailing Address - Country:US
Mailing Address - Phone:212-734-5533
Mailing Address - Fax:212-717-1688
Practice Address - Street 1:111 E 80TH ST
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0334
Practice Address - Country:US
Practice Address - Phone:212-734-5533
Practice Address - Fax:212-717-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty