Healthcare Provider Details

I. General information

NPI: 1134702483
Provider Name (Legal Business Name): RAHUL GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2097
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203-2097
US

V. Phone/Fax

Practice location:
  • Phone: 844-692-4692
  • Fax: 844-692-4692
Mailing address:
  • Phone: 844-692-4692
  • Fax: 844-692-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number328512-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: