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General NPI Number Information
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NPI Number | 1265771307
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Entity Type | Organization
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Legal Business Name | UPPER EAST SIDE GYNECOLOGY PLLC
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Dates
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Enumeration Date | 02/09/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 40 E 84TH ST
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City | NEW YORK
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State | NY
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Zip | 10028-1115
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Country | US
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Telephone | 212-472-6500
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Fax | 212-988-8737
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Provider Business Mailing Address
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Address Line | 40 E 84TH ST
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City | NEW YORK
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State | NY
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Zip | 10028-1115
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Country | US
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Telephone | 212-472-6500
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Fax | 212-988-8737
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARMIT ARCHIBALD
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Credential | MD
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Telephone | 212-472-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 216523
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License Number State | NY
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