Provider Demographics
NPI:1083262539
Name:UPTOWN SURGICAL SERVICES P.C
Entity Type:Organization
Organization Name:UPTOWN SURGICAL SERVICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-228-2202
Mailing Address - Street 1:111 EAST 71ST STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-288-2202
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 71ST STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-288-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical