MEDICARE: DEEPIKA THAKUR-GUPTA PT

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	2251N0400X	Neurology Physical Therapist	030257	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12421185	OTHER	NY	CAQH

General Provider Information

NPI Number	:	1770895500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPIKA THAKUR-GUPTA PT

Provider Business Mailing Address
First Line	:	7 PARK AVE APT 73
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4356
Country	:	US
Telephone Number	:	917-860-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W 45TH ST STE 301
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-4005
Country	:	US
Telephone Number	:	212-300-5545
Fax Number	:

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

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	12/17/2012

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