Provider Demographics
NPI:1881715779
Name:EASTSIDE MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:EASTSIDE MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-481-3600
Mailing Address - Street 1:20 E 46TH ST
Mailing Address - Street 2:RM 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:212-481-3600
Mailing Address - Fax:212-481-3336
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:RM 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
Practice Address - Country:US
Practice Address - Phone:212-481-3600
Practice Address - Fax:212-481-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty