Healthcare Provider Details

I. General information

NPI: 1023271004
Provider Name (Legal Business Name): ADEETI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
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

ADEETI GUPTA PHYSICIAN PC 66-83 70TH STREET
MIDDLE VILLAGE NY
11379
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax: 646-878-6095
Mailing address:
  • Phone: 718-898-1170
  • Fax: 718-898-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number265081
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number265081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: