Healthcare Provider Details

I. General information

NPI: 1407081094
Provider Name (Legal Business Name): ANURAG GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 PLANDOME RD # 169
MANHASSET NY
11030-1945
US

IV. Provider business mailing address

565 PLANDOME RD # 169
MANHASSET NY
11030-1945
US

V. Phone/Fax

Practice location:
  • Phone: 413-438-3626
  • Fax: 855-758-5681
Mailing address:
  • Phone: 413-438-3626
  • Fax: 855-758-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number273831-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number253070
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: