1588938682 NPI number — WEST SIDE GI, LLC

Table of content: (NPI 1588938682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588938682 NPI number — WEST SIDE GI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST SIDE GI, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588938682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 W 54TH ST
Provider Second Line Business Mailing Address:
8TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-3545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-874-3384
Provider Business Mailing Address Fax Number:
646-873-6600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 W 54TH ST
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-874-3384
Provider Business Practice Location Address Fax Number:
646-873-6600
Provider Enumeration Date:
03/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRASCO
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, HUMAN RESOURCES
Authorized Official Telephone Number:
212-889-3142

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  192097 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A300077871 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".