Healthcare Provider Details

I. General information

NPI: 1669726998
Provider Name (Legal Business Name): UPPER BREAST SIDE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 70TH ST SUITE 1L
NEW YORK NY
10023-4458
US

IV. Provider business mailing address

135 W 70TH ST SUITE 1L
NEW YORK NY
10023-4458
US

V. Phone/Fax

Practice location:
  • Phone: 212-873-2653
  • Fax:
Mailing address:
  • Phone: 212-873-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. FELINA SARA RAKOWSKI-GALLAGHER
Title or Position: PRESIDENT
Credential: CLC
Phone: 212-873-2653