MEDICARE: BAY AREA INFECTIOUS DISEASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	184610	NY
2	261QI0500X	Infusion Therapy Clinic/Center	184610	NY
3	261QP2300X	Primary Care Clinic/Center	184610	NY
4	261QM2500X	Medical Specialty Clinic/Center	184610	NY

General Provider Information

NPI Number	:	1740671130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA INFECTIOUS DISEASE

Provider Business Mailing Address
First Line	:	369 LEXINGTON AVE
Second Line	:	160 ST
City	:	NEW YORK
State	:	NY
Zip	:	10017-6506
Country	:	US
Telephone Number	:	646-237-7849
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 LEXINGTON AVE
Second Line	:	160 ST
City	:	NEW YORK
State	:	NY
Zip	:	10017-6506
Country	:	US
Telephone Number	:	646-237-7849
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. NEELAM TANEJA UPPAL
Credential	:	M.D.
Telephone Number	:	646-237-7849

Provider Enumeration Date	:	02/07/2015
Last Update Date	:	02/07/2015

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