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General NPI Number Information
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NPI Number | 1912417254
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Entity Type | Organization
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Legal Business Name | UPPER WEST SIDE MEDICAL DOCTOR PLLC
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Dates
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Enumeration Date | 09/30/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 46 W 86TH ST STE 1A
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City | NEW YORK
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State | NY
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Zip | 10024-3633
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Country | US
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Telephone | 908-962-1000
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Fax | 908-962-1000
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Provider Business Mailing Address
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Address Line | 46 W 86TH ST
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City | NEW YORK
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State | NY
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Zip | 10024-3633
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Country | US
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Telephone | 732-429-6513
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Fax | 917-472-1525
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Authorized Official
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Title or Position | OWNER
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Name | BHAVANA KRANTHI
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Credential | MD
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Telephone | 732-429-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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