Provider Demographics
NPI:1811440456
Name:UPTOWN NYC MEDICAL, INC
Entity type:Organization
Organization Name:UPTOWN NYC MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANJACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:MBABUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-559-0585
Mailing Address - Street 1:65 BROADWAY STE 1004
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2550
Mailing Address - Country:US
Mailing Address - Phone:646-559-0585
Mailing Address - Fax:646-559-2061
Practice Address - Street 1:65 BROADWAY STE 1004
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2550
Practice Address - Country:US
Practice Address - Phone:646-559-0585
Practice Address - Fax:646-559-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263896207X00000X, 208VP0000X
NY237589-12085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty