=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922123132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALTY ANESTHESIA INTERVENTIONS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 SAINT NICHOLAS AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11237-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-628-4057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7211 AUSTIN ST #481
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-5354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-255-2333
-----------------------------------------------------
Fax | 212-255-2455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SEKHAR C UPADHYAYULA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-255-2333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 209101
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------