Provider Demographics
NPI:1124277108
Name:HILLSIDE HEALTH MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:HILLSIDE HEALTH MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ECATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-856-6671
Mailing Address - Street 1:123 PIKE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1824
Mailing Address - Country:US
Mailing Address - Phone:845-856-6671
Mailing Address - Fax:845-858-9903
Practice Address - Street 1:123 PIKE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1824
Practice Address - Country:US
Practice Address - Phone:845-856-6671
Practice Address - Fax:845-858-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty