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General NPI Number Information
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NPI Number | 1760544837
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Entity Type | Organization
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Legal Business Name | EASTSIDE GYNECOLOGY SERVICES
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 144 E 44TH ST SUITE# 225
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City | NEW YORK
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State | NY
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Zip | 10017-4008
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Country | US
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Telephone | 212-308-4988
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Fax | 212-308-2221
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Provider Business Mailing Address
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Address Line | 144 E 44TH ST SUITE# 225
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City | NEW YORK
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State | NY
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Zip | 10017-4008
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Country | US
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Telephone | 212-308-4988
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Fax | 212-308-2221
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Authorized Official
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Title or Position | GROUP LEADER
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Name | DR. RONALD D. BLATT
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Credential | M.D.
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Telephone | 845-782-6485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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