Provider Demographics
NPI:1134291412
Name:UPSTATE PLASTIC SURGERY P.C.
Entity type:Organization
Organization Name:UPSTATE PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-346-3125
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-346-3125
Mailing Address - Fax:518-346-3541
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-346-3125
Practice Address - Fax:518-346-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56061AMedicare PIN