Provider Demographics
NPI:1609195254
Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity type:Organization
Organization Name:CITY MEDICAL OF UPPER EAST SIDE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYMENT SOLUTIONS
Authorized Official - Prefix:
Authorized Official - First Name:SWAHILI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-988-0428
Mailing Address - Street 1:1345 AVENUE OF THE AMERICAS FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10105-0018
Mailing Address - Country:US
Mailing Address - Phone:908-588-3635
Mailing Address - Fax:
Practice Address - Street 1:656 N WELLWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-4227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL OF UPPER EAST SIDE,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies