Provider Demographics
NPI:1396046843
Name:UPPER EASTSIDE INTERNAL MEDICINE
Entity type:Organization
Organization Name:UPPER EASTSIDE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIMMAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-346-5174
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10163-1821
Mailing Address - Country:US
Mailing Address - Phone:201-723-8776
Mailing Address - Fax:914-346-5174
Practice Address - Street 1:16 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:201-723-8776
Practice Address - Fax:914-346-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184535-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty