Provider Demographics
NPI:1922123132
Name:SPECIALTY ANESTHESIA INTERVENTIONS, PC
Entity Type:Organization
Organization Name:SPECIALTY ANESTHESIA INTERVENTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEKHAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:UPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-255-2333
Mailing Address - Street 1:7211 AUSTIN ST
Mailing Address - Street 2:#481
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5354
Mailing Address - Country:US
Mailing Address - Phone:212-255-2333
Mailing Address - Fax:212-255-2455
Practice Address - Street 1:129 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4039
Practice Address - Country:US
Practice Address - Phone:718-628-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209101207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990601Medicaid
NY1068641OtherAETNA USHC
NY00209101OtherMETROPLUS
NY3575367OtherAETNA USHC (COMMERCIAL)
NY902285001OtherAMERICHOICE
NY0385TOtherEMPIRE BCBS
NY175973OtherELDERPLAN
NY209101OtherHIP
NYN299460OtherWELLCARE
NY00209101OtherMETROPLUS
NYN299460OtherWELLCARE