Provider Demographics
NPI:1639664881
Name:UPSTATE CONCIERGE MEDICINE PLLC
Entity type:Organization
Organization Name:UPSTATE CONCIERGE MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBIGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-268-2506
Mailing Address - Street 1:216 RIVER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3848
Mailing Address - Country:US
Mailing Address - Phone:518-268-2506
Mailing Address - Fax:844-819-1020
Practice Address - Street 1:216 RIVER ST STE 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3848
Practice Address - Country:US
Practice Address - Phone:518-268-2506
Practice Address - Fax:844-819-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty