Individual
ATUL MAINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5100 W TAFT RD STE 2E, UPSTATE SURGICAL GROUP P.C., LIVERPOOL, NY 13088-4841
(315) 634-3399
(315) 634-3481
Mailing address
5100 W TAFT RD STE 2E, UPSTATE SURGICAL GROUP P.C., LIVERPOOL, NY 13088-4841
(315) 634-3999
(315) 634-3481
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
002108
NY
208600000X
Surgery Physician
Primary
239516
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02586827
—
NY
01
—
239516
MA BORM LICENSE
MA
01
—
M0000000
MEDICARE (PENDING)
MA
Enumeration date
04/18/2006
Last updated
01/10/2011
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