Provider Demographics
NPI:1861527731
Name:WESTSIDE PEDIATRIC ASSOSOATES
Entity type:Organization
Organization Name:WESTSIDE PEDIATRIC ASSOSOATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHAIMAN, PEDIATRIC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FARROUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHRIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-523-3760
Mailing Address - Street 1:1111 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1716
Mailing Address - Country:US
Mailing Address - Phone:212-523-8050
Mailing Address - Fax:212-523-8055
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-8306
Practice Address - Fax:232-523-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
NY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID