Organization
UPPER WEST SIDE MEDICAL DOCTOR PLLC
Active
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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