Provider Demographics
NPI:1184724189
Name:NORTHEAST PEDIATRICS & ADOLESCENT MEDICINE, LLP
Entity type:Organization
Organization Name:NORTHEAST PEDIATRICS & ADOLESCENT MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARUGERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:UPHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-257-2244
Mailing Address - Street 1:10 GRAHAM RD W
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1055
Mailing Address - Country:US
Mailing Address - Phone:607-257-2244
Mailing Address - Fax:607-266-7341
Practice Address - Street 1:10 GRAHAM RD W
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1055
Practice Address - Country:US
Practice Address - Phone:607-257-2244
Practice Address - Fax:607-266-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty