Upstate Vascular Study Lab, Inc

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

License

124377 Issued in NY

Legal business name

UPSTATE VASCULAR STUDY LAB, INC

Practice address

2655 Ridgeway Avenue
Suite # 260
Rochester, NY 14626

Phone

(585) 720-0818

Fax

(585) 720-5427

NPI assigned

Apr 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tiffany A. Burgen

Title

Office Manager

Phone

(585) 720-0818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Upstate Vascular Study Lab Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1194782938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 RIDGEWAY AVENUE",
            "address_2": "SUITE # 260",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14626",
            "telephone_number": "585-720-0818",
            "fax_number": "585-720-5427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 RIDGEWAY AVENUE",
            "address_2": "SUITE # 260",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14626",
            "telephone_number": "585-720-0818",
            "fax_number": "585-720-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE VASCULAR STUDY LAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "BURGEN",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "585-720-0818",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NY",
            "license": "124377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00446135",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upstate Vascular Study Lab",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kerry Upshaw, CASAC
• Odell Upshaw Jr.
• Upstate Care Management Services Inc
• Upstate Ketamine Care
• Upstate Regional Medical Supply ,Inc.
• Kim Urbach, NP
• Urban Affairs Inc.
• Urban League of Rochester, N.Y., Inc.
• Abigail Urban-Rifkin, LMHC, CASAC
• Breanne Darlene Urban, PHARMD

• Physiological Laboratory in Rochester, NY
• Providers in Rochester, NY by specialty
• Physiological Laboratory in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.