NPIMap

Organization Active NPI

Eastside Physicians of Nyc, PLLC

Doing business as MiDoctor

  • Family Medicine Physician
  • New York, NY
National Provider Identifier
1144947029
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EASTSIDE PHYSICIANS OF NYC, PLLC
Doing business as
MiDoctor
Practice address
420 E 51St St Ofc a
New York, NY 10022-8014
Phone
(212) 688-8887
Fax
(212) 688-1243
NPI assigned
Oct 21, 2022
Last updated
Oct 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Vino K Palli, MDNPI 1013080167
Title
Ceo
Phone
(773) 220-8466

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

420 E 51St St Ofc a
New York, NY 10022-8014

Mailing address

715 9TH Ave
New York, NY 10019-7359
Phone (212) 757-3859

Other practice location 1

715 9th Ave
New York, NY 10019-7359
Phone (212) 757-3859

Other practice location 2

1226 3rd Ave
New York, NY 10021
Phone (646) 609-1012

Other names 1

  • MiDoctor Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.midochealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230117002147 NY Part B Supplier - Clinic/Group Practice 1052780517 Receives reassigned benefits from 16 practitioners
Practice locations: New York, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1226 3rd Ave
New York, NY 10021
Phone (212) 757-2015

715 9th Ave
New York, NY 10019
Phone (212) 757-2015

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1144947029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 9TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100197359",
            "telephone_number": "212-757-3859",
            "fax_number": "212-757-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E 51ST ST OFC A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100228014",
            "telephone_number": "212-688-8887",
            "fax_number": "212-688-1243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 9th Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100197359",
            "country_code": "US",
            "telephone_number": "212-757-3859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1226 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10021",
            "country_code": "US",
            "telephone_number": "646-609-1012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTSIDE PHYSICIANS OF NYC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-21",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "PALLI",
        "authorized_official_first_name": "VINO",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-220-8466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.midochealth.com",
            "affiliation": "N",
            "address_1": "420 E 51st St Ofc A",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100228014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MiDoctor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.