Healthcare Provider Details

I. General information

NPI: 1477790061
Provider Name (Legal Business Name): NITIN GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ASHFORD AVE STE 3W
DOBBS FERRY NY
10522-1824
US

IV. Provider business mailing address

18 ASHFORD AVE STE 3W
DOBBS FERRY NY
10522-1824
US

V. Phone/Fax

Practice location:
  • Phone: 914-330-8445
  • Fax: 914-330-8446
Mailing address:
  • Phone: 914-330-8445
  • Fax: 914-330-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number253963
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03524834
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: