Organization
UPPER WEST SIDE MEDICAL DOCTOR PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHAVANA KRANTHI MD (OWNER)
(732) 429-6513
Entity
Organization
Contact information
Practice address
46 W 86TH ST STE 1A, NEW YORK, NY 10024-3633
(908) 962-1000
(908) 962-1000
Mailing address
46 W 86TH ST, NEW YORK, NY 10024-3633
(732) 429-6513
(917) 472-1525
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
287857
NY STATE LICENSE
NY
Enumeration date
09/30/2017
Last updated
12/05/2017
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