Provider Demographics
NPI:1104281245
Name:WESTSIDE ONCOLOGY MEDICAL ASSOCIATES, P.L.L.C.
Entity type:Organization
Organization Name:WESTSIDE ONCOLOGY MEDICAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-996-5900
Mailing Address - Street 1:521 W 57TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2929
Mailing Address - Country:US
Mailing Address - Phone:557-996-5848
Mailing Address - Fax:551-996-8578
Practice Address - Street 1:521 W 57TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2929
Practice Address - Country:US
Practice Address - Phone:551-996-4280
Practice Address - Fax:551-996-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1603621207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty