Provider Demographics
NPI:1851487094
Name:UPPER WESTSIDE OPTHALMOLOGY EYECARE
Entity type:Organization
Organization Name:UPPER WESTSIDE OPTHALMOLOGY EYECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-662-0399
Mailing Address - Street 1:1090 AMSTERDAM AVENUE
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-662-0399
Mailing Address - Fax:212-662-0259
Practice Address - Street 1:1090 AMSTERDAM AVENUE
Practice Address - Street 2:SUITE 9A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-662-0399
Practice Address - Fax:212-662-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
19A321OtherEMPIRE HEALTHCHOICE