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General NPI Number Information
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NPI Number | 1629272141
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Entity Type | Organization
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Legal Business Name | UPSTATE ANESTHESIA SERVICES, P.C.
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 2201 HEMPSTEAD TPKE DEPT OF
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City | EAST MEADOW
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State | NY
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Zip | 11554-1859
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Country | US
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Telephone | 877-580-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 450 MAMARONECK AVE
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City | HARRISON
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State | NY
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Zip | 10528-2400
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Country | US
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Telephone | 914-637-3510
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Fax | 914-365-6307
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. MARC E. KOCH
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Credential | M.D.
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Telephone | 877-476-6642
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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