Provider Demographics
NPI:1366430290
Name:UPADHYAY, YOGENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:YOGENDRA
Middle Name:
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BROADWAY STE 6
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2797
Mailing Address - Country:US
Mailing Address - Phone:516-908-9768
Mailing Address - Fax:516-801-4361
Practice Address - Street 1:116 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2797
Practice Address - Country:US
Practice Address - Phone:516-908-9768
Practice Address - Fax:516-801-4361
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108074-12084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00190625Medicaid
NY289041Medicare ID - Type Unspecified
NY00190625Medicaid