| Lower Eastside Service Center, Inc. | |
|
46 E Broadway New York NY 10002-6803 | |
| (212) 343-3533 | |
| Not Available |
| Full Name | Lower Eastside Service Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 46 E Broadway, New York, New York |
| Authorized Official Name and Position | Lee Hunter Pavis (VP, CFO-CIO) |
| Authorized Official Contact | 2125667713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lower Eastside Service Center, Inc. 80 Maiden Ln Floor 2 New York NY 10038-4811 Ph: (212) 566-5372 | Lower Eastside Service Center, Inc. 46 E Broadway New York NY 10002-6803 Ph: (212) 343-3533 |
| NPI Number | 1063637817 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 09/17/2008 |
| Medicare PECOS PAC ID | 4880586080 |
|---|---|
| Medicare Enrollment ID | O20060317000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063637817 | NPI | - | NPPES |
| 00245689 | Medicaid | NY |
| Provider Name | Esther O Ndukwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912122318 PECOS PAC ID: 6709986573 Enrollment ID: I20081125000804 |
| Provider Name | Joseph Gallo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720059975 PECOS PAC ID: 7618288168 Enrollment ID: I20150624002089 |
| Provider Name | Kenneth C Levy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992929707 PECOS PAC ID: 3577872662 Enrollment ID: I20151012000208 |
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