Provider Demographics
NPI:1043493000
Name:UPPER WEST SIDE MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:UPPER WEST SIDE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-926-5050
Mailing Address - Street 1:464 WEST 145 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031
Mailing Address - Country:US
Mailing Address - Phone:212-926-5050
Mailing Address - Fax:212-926-7778
Practice Address - Street 1:464 WEST 145 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:212-926-5050
Practice Address - Fax:212-926-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185152207R00000X
NY235917207R00000X
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00639791OtherRAILROAD MEDICARE GROUP MEMBER PTAN
NYDN8039OtherRAILROAD MEDICARE GROUP PTAN
NY02974472Medicaid
NY8648N25581Medicare PIN
NYW25581Medicare PIN
NY74K5925581Medicare PIN