Healthcare Provider Details

I. General information

NPI: 1417158445
Provider Name (Legal Business Name): UPA NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BERGEN STREET ADMC 12 1205
NEWARK NJ
07107-3000
US

IV. Provider business mailing address

30 BERGEN STREET ADMC 12 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-0037
  • Fax: 973-972-9355
Mailing address:
  • Phone: 973-972-0037
  • Fax: 973-972-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SIMI BAKSHI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 973-972-6713