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General NPI Number Information
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NPI Number | 1144947029
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Entity Type | Organization
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Legal Business Name | EASTSIDE PHYSICIANS OF NYC, PLLC
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 420 E 51ST ST OFC A
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City | NEW YORK
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State | NY
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Zip | 10022-8014
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Country | US
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Telephone | 212-688-8887
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Fax | 212-688-1243
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Provider Business Mailing Address
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Address Line | 715 9TH AVE
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City | NEW YORK
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State | NY
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Zip | 10019-7359
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Country | US
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Telephone | 212-757-3859
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Fax | 212-757-2815
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Authorized Official
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Title or Position | CEO
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Name | DR. VINO K PALLI
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Credential | MD
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Telephone | 773-220-8466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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