Healthcare Provider Details

I. General information

NPI: 1104281245
Provider Name (Legal Business Name): WESTSIDE ONCOLOGY MEDICAL ASSOCIATES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 57TH ST 4TH FLOOR
NEW YORK NY
10019-2929
US

IV. Provider business mailing address

521 W 57TH ST 4TH FLOOR
NEW YORK NY
10019-2929
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4280
  • Fax: 551-996-0729
Mailing address:
  • Phone: 557-996-5848
  • Fax: 551-996-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1603621
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREW L. PECORA
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 551-996-5900