Provider Demographics
NPI:1588938682
Name:WEST SIDE GI, LLC
Entity type:Organization
Organization Name:WEST SIDE GI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-889-3142
Mailing Address - Street 1:619 W 54TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3545
Mailing Address - Country:US
Mailing Address - Phone:212-874-3384
Mailing Address - Fax:646-873-6600
Practice Address - Street 1:619 W 54TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3545
Practice Address - Country:US
Practice Address - Phone:212-874-3384
Practice Address - Fax:646-873-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192097261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300077871OtherMEDICARE PTAN