Healthcare Provider Details

I. General information

NPI: 1548208226
Provider Name (Legal Business Name): EAST SIDE PSYCHIATRIC SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E 76TH ST 4TH FLOOR
NEW YORK NY
10021-3104
US

IV. Provider business mailing address

416 E 76TH ST 4TH FLOOR
NEW YORK NY
10021-3104
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-5393
  • Fax:
Mailing address:
  • Phone: 212-434-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM S BELFAR
Title or Position: OWNER
Credential: MD
Phone: 212-434-5393