Healthcare Provider Details

I. General information

NPI: 1922053768
Provider Name (Legal Business Name): UPSTATE CARDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST SUITE 201
VALATIE NY
12184-9694
US

IV. Provider business mailing address

1301 RIVER ST SUITE 201
VALATIE NY
12184-9694
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-2055
  • Fax: 518-758-2057
Mailing address:
  • Phone: 518-758-2055
  • Fax: 518-758-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2005731
License Number StateNY

VIII. Authorized Official

Name: DR. PRINCEWILL O OGBUJI
Title or Position: MD/OWNER
Credential: M.D.
Phone: 518-758-2055