Healthcare Provider Details

I. General information

NPI: 1447509989
Provider Name (Legal Business Name): ADEETI GUPTA PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379-2191
US

IV. Provider business mailing address

7001 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379-2191
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax: 646-878-6095
Mailing address:
  • Phone: 917-410-6905
  • Fax: 646-878-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number265081
License Number State

VIII. Authorized Official

Name: DR. ADEETI GUPTA
Title or Position: PRESIDENT
Credential: MD
Phone: 516-652-3346