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General NPI Number Information
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NPI Number | 1992702443
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Entity Type | Organization
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Legal Business Name | THE EASTSIDE ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1135 116TH AVE NE SUITE 570
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City | BELLEVUE
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State | WA
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Zip | 98004-4623
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Country | US
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Telephone | 425-451-7335
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Fax | 425-451-1226
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Provider Business Mailing Address
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Address Line | 1135 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-4623
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Country | US
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Telephone | 425-544-7684
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Fax | 425-462-8021
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Authorized Official
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Title or Position | COO
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Name | NICOLAS GORALSKY
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Credential |
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Telephone | 253-383-8342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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