Provider Demographics
NPI:1184170821
Name:UPSTATE PSYCHIATRY, PC
Entity type:Organization
Organization Name:UPSTATE PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ADEKOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-638-0979
Mailing Address - Street 1:3070 BELGIUM RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9239
Mailing Address - Country:US
Mailing Address - Phone:315-638-0979
Mailing Address - Fax:315-638-0835
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9239
Practice Address - Country:US
Practice Address - Phone:315-638-0979
Practice Address - Fax:315-638-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21340812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300299983Medicare UPIN