Provider Demographics
NPI:1982905626
Name:EASTSIDE PEDIATRICS LLC
Entity Type:Organization
Organization Name:EASTSIDE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LESESNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-523-1102
Mailing Address - Street 1:625 BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1977
Mailing Address - Country:US
Mailing Address - Phone:973-523-1102
Mailing Address - Fax:973-523-7309
Practice Address - Street 1:625 BROADWAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1977
Practice Address - Country:US
Practice Address - Phone:973-523-1102
Practice Address - Fax:973-523-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty