Provider Demographics
NPI:1144947029
Name:EASTSIDE PHYSICIANS OF NYC, PLLC
Entity type:Organization
Organization Name:EASTSIDE PHYSICIANS OF NYC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINO
Authorized Official - Middle Name:K
Authorized Official - Last Name:PALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-220-8466
Mailing Address - Street 1:715 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7359
Mailing Address - Country:US
Mailing Address - Phone:212-757-3859
Mailing Address - Fax:212-757-2815
Practice Address - Street 1:420 E 51ST ST OFC A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8014
Practice Address - Country:US
Practice Address - Phone:212-688-8887
Practice Address - Fax:212-688-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty