Provider Demographics
NPI:1457044174
Name:UPTOWN NEPHROLOGY MEDICINE PC
Entity Type:Organization
Organization Name:UPTOWN NEPHROLOGY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-429-2004
Mailing Address - Street 1:1025 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-9107
Mailing Address - Country:US
Mailing Address - Phone:917-715-6417
Mailing Address - Fax:718-228-5909
Practice Address - Street 1:1025 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-9107
Practice Address - Country:US
Practice Address - Phone:917-715-6417
Practice Address - Fax:718-228-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty