Provider Demographics
NPI: | 1508067539 |
---|---|
Name: | UPA NP LLC |
Entity Type: | Organization |
Organization Name: | UPA NP LLC |
Other - Org Name: | UNIVERSITY NEURO-OPHTHALMOLOGY ASSOCIATES NP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SIMI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BAKSHI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 973-972-6713 |
Mailing Address - Street 1: | 30 BERGEN STREET |
Mailing Address - Street 2: | ADMC 12 1205 |
Mailing Address - City: | NEWARK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07107-3000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-972-0037 |
Mailing Address - Fax: | 973-972-9355 |
Practice Address - Street 1: | 30 BERGEN STREET |
Practice Address - Street 2: | ADMC 12 1205 |
Practice Address - City: | NEWARK |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07107-3000 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-972-0037 |
Practice Address - Fax: | 973-972-9355 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-29 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Single Specialty |