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General NPI Number Information
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NPI Number | 1174194856
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Entity Type | Organization
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Legal Business Name | UPSTATE URGENT CARE PLLC
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 1000 RAILROAD AVE APT 1
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City | WOODMERE
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State | NY
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Zip | 11598-1645
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Country | US
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Telephone | 516-748-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 59TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-2130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | BLIMY JACOBS
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Credential |
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Telephone | 845-662-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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