# UPSTATE VASCULAR STUDY LAB, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Upstate Vascular Study Lab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194782938
- **Authorized official:** MRS. TIFFANY A. BURGEN (OFFICE MANAGER)
- **Authorized official phone:** (585) 720-0818

## Contact information

- **Practice address:** 2655 RIDGEWAY AVENUE, SUITE \# 260, ROCHESTER, NY 14626
- **Practice address phone:** (585) 720-0818
- **Practice address fax:** (585) 720-5427
- **Mailing address:** 2655 RIDGEWAY AVENUE, SUITE \# 260, ROCHESTER, NY 14626
- **Mailing address phone:** (585) 720-0818
- **Mailing address fax:** (585) 720-5427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | 124377 | NY | Yes |

## Other

- **Enumeration date:** 04/26/2006
- **Last updated:** 02/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00446135 | — | NY |