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General NPI Number Information
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NPI Number | 1083141964
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Entity Type | Organization
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Legal Business Name | UPSTATE PSYCHIATRY
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 115 SULLYS TRL STE 4
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City | PITTSFORD
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State | NY
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Zip | 14534-4571
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Country | US
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Telephone | 585-662-5945
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Fax | 585-673-2181
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Provider Business Mailing Address
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Address Line | 115 SULLYS TRL STE 4
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City | PITTSFORD
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State | NY
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Zip | 14534-4571
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Country | US
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Telephone | 585-662-5945
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Fax | 585-673-2181
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MUHAMMAD CHEEMA
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Credential | MD
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Telephone | 585-662-5945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 233735
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License Number State | NY
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