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General NPI Number Information
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NPI Number | 1275687261
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Entity Type | Organization
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Legal Business Name | AMIT UPADHIAYA DO PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1 W SAMPLE RD STE 201
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3547
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Country | US
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Telephone | 954-782-3170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50451
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33074-0451
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Country | US
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Telephone | 954-782-3170
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. AMIT UPADHIAYA
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Credential | DO
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Telephone | 954-782-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 059136
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License Number State | FL
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