Healthcare Provider Details

I. General information

NPI: 1740894906
Provider Name (Legal Business Name): NIDHI GUPTA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIDHI ARORA

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COMMUNITY DRIVE, SUITE 110
GREAT NECK NY
11021
US

IV. Provider business mailing address

225 COMMUNITY DRIVE, SUITE 110
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-918-4802
  • Fax: 516-918-4839
Mailing address:
  • Phone: 646-714-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number338414
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number338414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: