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General NPI Number Information
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NPI Number | 1467539874
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Entity Type | Organization
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Legal Business Name | WESTSIDE FAMILY MEDICINE PLLC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 535 W 110TH ST APT 1E
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City | NEW YORK
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State | NY
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Zip | 10025-2021
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Country | US
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Telephone | 212-280-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W 108TH ST APT 13A
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City | NEW YORK
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State | NY
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Zip | 10025-2788
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Country | US
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Telephone |
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Fax | 212-280-4743
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERTIE BREGMAN
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Credential |
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Telephone | 212-280-4740
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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 | 213539
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License Number State | NY
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