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General NPI Number Information
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NPI Number | 1528188430
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Entity Type | Organization
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Legal Business Name | EASTSIDE MEDICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 111 E 88TH ST STE 1A
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City | NEW YORK
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State | NY
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Zip | 10128-1111
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Country | US
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Telephone | 212-288-2278
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Fax | 212-517-4077
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Provider Business Mailing Address
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Address Line | 111 E 88TH ST STE 1A
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City | NEW YORK
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State | NY
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Zip | 10128-1111
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Country | US
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Telephone | 212-288-2278
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Fax | 212-517-4077
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | JEFFREY M. LORIA
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Credential | M.D.
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Telephone | 212-288-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 165740
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 165740
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 178028
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 165740
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 178028
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 165740
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License Number State | NY
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