Provider Demographics
NPI:1336490663
Name:BHUPINDER SINGH BOLLA MD PLLC
Entity Type:Organization
Organization Name:BHUPINDER SINGH BOLLA MD PLLC
Other - Org Name:PAIN SOLUTIONS OF NORTHERN NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-7246
Mailing Address - Street 1:26561 STATE ROUTE 3 STE A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1749
Mailing Address - Country:US
Mailing Address - Phone:315-782-7246
Mailing Address - Fax:
Practice Address - Street 1:107 COURT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2534
Practice Address - Country:US
Practice Address - Phone:315-782-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02601054Medicaid
NY02601054Medicaid