MEDICARE: CITY MEDICAL OF UPPER EAST SIDE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1417517012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY MEDICAL OF UPPER EAST SIDE, PLLC

Provider Business Mailing Address
First Line	:	1345 AVENUE OF THE AMERICAS FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10105-0018
Country	:	US
Telephone Number	:	908-588-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2004
Country	:	US
Telephone Number	:	646-647-1257
Fax Number	:	646-647-1258

Authorized Official
Title or Position	:	DIRECTOR OF PAYMENT SOLUTIONS
Name	:	SWAHILI HENRY
Credential	:
Telephone Number	:	908-988-0428

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	03/05/2025

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