Healthcare Provider Details

I. General information

NPI: 1629272141
Provider Name (Legal Business Name): UPSTATE ANESTHESIA SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE DEPT OF
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

450 MAMARONECK AVE
HARRISON NY
10528-2400
US

V. Phone/Fax

Practice location:
  • Phone: 877-580-4635
  • Fax:
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-365-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC E. KOCH
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 877-476-6642