Healthcare Provider Details

I. General information

NPI: 1720327372
Provider Name (Legal Business Name): CITY MEDICAL OF UPPER EAST SIDE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 GLEN COVE RD
CARLE PLACE NY
11514-1221
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 516-783-4600
  • Fax: 516-783-4612
Mailing address:
  • Phone: 908-588-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SWAHILI HENRY
Title or Position: DIRECTOR OF PAYMENT SOLUTIONS
Credential:
Phone: 908-988-0428