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General NPI Number Information
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NPI Number | 1114054558
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Entity Type | Organization
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Legal Business Name | EAST SIDE CARDIOLOGY PLLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 370 E 76TH ST SUITE C101
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City | NEW YORK
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State | NY
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Zip | 10021-2547
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Country | US
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Telephone | 212-535-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 370 E 76TH ST SUITE C101
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City | NEW YORK
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State | NY
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Zip | 10021-2547
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Country | US
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Telephone | 212-535-0106
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSHUA A. DONIS
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Credential | MD
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Telephone | 212-531-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 210657
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License Number State | NY
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