Healthcare Provider Details

I. General information

NPI: 1962444802
Provider Name (Legal Business Name): ARUN KUMAR GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 MERRICK AVE
MERRICK NY
11566-1628
US

IV. Provider business mailing address

1703 MERRICK AVE
MERRICK NY
11566-1628
US

V. Phone/Fax

Practice location:
  • Phone: 516-378-3311
  • Fax: 516-546-1517
Mailing address:
  • Phone: 516-378-3311
  • Fax: 516-546-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number161794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: