Healthcare Provider Details

I. General information

NPI: 1558904045
Provider Name (Legal Business Name): UPWORD MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 JAMAICA AVE
WOODHAVEN NY
11421-2282
US

IV. Provider business mailing address

9525 JAMAICA AVE
WOODHAVEN NY
11421-2282
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-4070
  • Fax: 718-441-4027
Mailing address:
  • Phone: 718-441-4070
  • Fax: 718-441-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK KOSTIN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-441-4070