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General NPI Number Information
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NPI Number | 1265742431
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Entity Type | Organization
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Legal Business Name | EXPERT PAIN MANAGEMENT PC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 50 HOSPITAL HILL RD 2ND FLOOR
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City | SHARON
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State | CT
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Zip | 06069-2096
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Country | US
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Telephone | 860-364-4458
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MIRON DR
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5020
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Country | US
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Telephone | 845-849-3336
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NAGENDRA P UPADHYAYULA
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Credential | M.D.,
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Telephone | 845-849-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 49099
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License Number State | CT
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