Provider Demographics
NPI:1750766762
Name:WESTSIDE NEW YORK MEDICAL, PC
Entity type:Organization
Organization Name:WESTSIDE NEW YORK MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MD
Authorized Official - Prefix:
Authorized Official - First Name:NONYELU
Authorized Official - Middle Name:IRUOMA
Authorized Official - Last Name:ANYICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-699-7700
Mailing Address - Street 1:40 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1322
Mailing Address - Country:US
Mailing Address - Phone:914-699-7700
Mailing Address - Fax:914-699-7701
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-699-7700
Practice Address - Fax:914-699-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty