Provider Demographics
NPI:1831323872
Name:UPPER EAST SIDE MEDICAL PC
Entity type:Organization
Organization Name:UPPER EAST SIDE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KLETSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-974-3001
Mailing Address - Street 1:105 OCEANA DR E
Mailing Address - Street 2:5I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 OCEANA DR E
Practice Address - Street 2:5I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6681
Practice Address - Country:US
Practice Address - Phone:917-974-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty