Healthcare Provider Details

I. General information

NPI: 1578710588
Provider Name (Legal Business Name): ADVENT MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 AUSTIN ST SUITE 303
FOREST HILLS NY
11375-4245
US

IV. Provider business mailing address

322 W 57TH ST APT 50U
NEW YORK NY
10019-3701
US

V. Phone/Fax

Practice location:
  • Phone: 718-897-0008
  • Fax: 718-897-1002
Mailing address:
  • Phone: 718-897-0008
  • Fax: 718-897-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number186054
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier01642433
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. NINA GUPTA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 718-897-0008