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General NPI Number Information
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NPI Number | 1710262266
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Entity Type | Organization
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Legal Business Name | CITY MEDICAL OF THE UPPER WEST SIDE PLLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 2398 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10024-1703
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Country | US
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Telephone | 212-722-3672
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 RXR PLZ
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City | UNIONDALE
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State | NY
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Zip | 11556-1301
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Country | US
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Telephone | 516-783-4600
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RICHARD PARK
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Credential | M.D.
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Telephone | 516-783-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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