Healthcare Provider Details

I. General information

NPI: 1144947029
Provider Name (Legal Business Name): EASTSIDE PHYSICIANS OF NYC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 51ST ST OFC A
NEW YORK NY
10022-8014
US

IV. Provider business mailing address

715 9TH AVE
NEW YORK NY
10019-7359
US

V. Phone/Fax

Practice location:
  • Phone: 212-688-8887
  • Fax: 212-688-1243
Mailing address:
  • Phone: 212-757-3859
  • Fax: 212-757-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINO K PALLI
Title or Position: CEO
Credential: MD
Phone: 773-220-8466