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NPI Code Detail

MEDICARE: HILLSIDE HEALTH MEDICAL PRACTICE, P.C.

MEDICARE: HILLSIDE HEALTH MEDICAL PRACTICE, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1124277108
Entity Type Code : Organization
Provider Name (Legal Business Name) : HILLSIDE HEALTH MEDICAL PRACTICE, P.C.
Provider Business Mailing Address
First Line : 123 PIKE ST
Second Line : SUITE 209
City : PORT JERVIS
State : NY
Zip : 12771-1824
Country : US
Telephone Number : 845-856-6671
Fax Number : 845-858-9903
Provider Business Practice Location Address
First Line : 123 PIKE ST
Second Line : SUITE 209
City : PORT JERVIS
State : NY
Zip : 12771-1824
Country : US
Telephone Number : 845-856-6671
Fax Number : 845-858-9903
Authorized Official
Title or Position : PRESIDENT
Name : ECATERINA IRIZA
Credential : M.D.
Telephone Number : 845-856-6671
Provider Enumeration Date : 09/15/2008
Last Update Date : 09/15/2008

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Directions to “HILLSIDE HEALTH MEDICAL PRACTICE, P.C. ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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