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General NPI Number Information
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NPI Number | 1639664881
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Entity Type | Organization
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Legal Business Name | UPSTATE CONCIERGE MEDICINE PLLC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 169 MADISON AVE STE 15370
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 844-484-7362
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Fax | 518-205-7554
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 15370
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 844-484-7362
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Fax | 518-205-7554
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MICHAEL BIBIGHAUS
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Credential | MD
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Telephone | 518-268-2506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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