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General NPI Number Information
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NPI Number | 1447633805
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Entity Type | Individual
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Provider Name | GAUTHAM KADIYALI UPADHYA MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1161 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3621
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Country | US
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Telephone | 718-818-7425
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Fax | 855-448-7807
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Provider Business Mailing Address
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Address Line | 1161 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3621
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Country | US
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Telephone | 718-818-7425
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Fax | 855-448-7807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 294581
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 246XC2901X
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Taxonomy Name | Cardiovascular Invasive Specialist/Technologist
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License Number |
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License Number State |
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