MEDICARE: SAROJ GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	150180	NY

General Provider Information

NPI Number	:	1396749214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAROJ GUPTA MD

Provider Business Mailing Address
First Line	:	18016 WEXFORD TER
Second Line	:	STE CB
City	:	JAMAICA
State	:	NY
Zip	:	11432-3004
Country	:	US
Telephone Number	:	718-658-5639
Fax Number	:	718-865-9108

Provider Business Practice Location Address
First Line	:	18016 WEXFORD TER
Second Line	:	STE CB
City	:	JAMAICA
State	:	NY
Zip	:	11432-3004
Country	:	US
Telephone Number	:	718-658-5639
Fax Number	:	718-865-9108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/19/2011

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