Provider Demographics
NPI:1558904045
Name:UPWORD MEDICAL P.C.
Entity Type:Organization
Organization Name:UPWORD MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-441-4070
Mailing Address - Street 1:9525 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2282
Mailing Address - Country:US
Mailing Address - Phone:718-441-4070
Mailing Address - Fax:718-441-4027
Practice Address - Street 1:9525 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2282
Practice Address - Country:US
Practice Address - Phone:718-441-4070
Practice Address - Fax:718-441-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty