Healthcare Provider Details

I. General information

NPI: 1649768904
Provider Name (Legal Business Name): CITY MEDICAL OF UPPER EAST SIDE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 OLD COUNTRY RD
PLAINVIEW NY
11803-5019
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-5900
  • Fax: 516-495-4577
Mailing address:
  • Phone: 908-588-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SWAHILI HENRY
Title or Position: DIRECTOR OF PAYMENT SOLUTIONS
Credential:
Phone: 908-988-0428