Healthcare Provider Details

I. General information

NPI: 1588938682
Provider Name (Legal Business Name): WEST SIDE GI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W 54TH ST 8TH FLOOR
NEW YORK NY
10019-3545
US

IV. Provider business mailing address

619 W 54TH ST 8TH FLOOR
NEW YORK NY
10019-3545
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-3384
  • Fax: 646-873-6600
Mailing address:
  • Phone: 212-874-3384
  • Fax: 646-873-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number192097
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE FRASCO
Title or Position: DIRECTOR, HUMAN RESOURCES
Credential:
Phone: 212-889-3142