Provider Demographics
NPI:1740728013
Name:UPSTATE PHYSICIAN SERVICES, PC
Entity type:Organization
Organization Name:UPSTATE PHYSICIAN SERVICES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-687-1960
Mailing Address - Street 1:2001 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-687-1960
Mailing Address - Fax:518-687-1970
Practice Address - Street 1:2001 5TH AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-687-1960
Practice Address - Fax:518-687-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171212063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty