Healthcare Provider Details

I. General information

NPI: 1093719742
Provider Name (Legal Business Name): SWARN KUMAR GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18016 WEXFORD TER STE CC
JAMAICA NY
11432-3004
US

IV. Provider business mailing address

180 16 WEXFORD TERRACE SUITE CC
JAMAICA NY
11432-3000
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-6434
  • Fax: 718-657-5606
Mailing address:
  • Phone: 718-657-6434
  • Fax: 718-657-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number137721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: