Provider Demographics
NPI:1255355830
Name:UPSTATE GASTROENTEROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:UPSTATE GASTROENTEROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-1199
Mailing Address - Street 1:2200 BURDETT AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2451
Mailing Address - Country:US
Mailing Address - Phone:518-272-0234
Mailing Address - Fax:518-272-0906
Practice Address - Street 1:2200 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2451
Practice Address - Country:US
Practice Address - Phone:518-272-0234
Practice Address - Fax:518-272-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9024OtherRAILROAD MEDICARE
NYCC9024OtherRAILROAD MEDICARE