Healthcare Provider Details

I. General information

NPI: 1740238906
Provider Name (Legal Business Name): SANJAY GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

IV. Provider business mailing address

65 VIA FORESTA LANE
WILLIAMSVILLE NY
14221-1982
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax: 716-332-4488
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number182506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: