Healthcare Provider Details

I. General information

NPI: 1184758260
Provider Name (Legal Business Name): UPTOWN MEDICAL LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 149TH ST
BRONX NY
10451-5601
US

IV. Provider business mailing address

305 E 149TH ST
BRONX NY
10451-5601
US

V. Phone/Fax

Practice location:
  • Phone: 718-401-8030
  • Fax:
Mailing address:
  • Phone: 718-401-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number186421
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number165573
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRIS B MARTI
Title or Position: MANAGER
Credential:
Phone: 718-401-8030