Healthcare Provider Details

I. General information

NPI: 1497378467
Provider Name (Legal Business Name): NICKHIL GUPTA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W CENTURY RD STE 106
PARAMUS NJ
07652-1466
US

IV. Provider business mailing address

26 FIREMENS MEMORIAL DR STE 115
POMONA NY
10970-3569
US

V. Phone/Fax

Practice location:
  • Phone: 800-750-8616
  • Fax: 845-362-8474
Mailing address:
  • Phone: 845-362-8400
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICKHIL GUPTA
Title or Position: OWNER
Credential: MD
Phone: 800-750-8616