Healthcare Provider Details

I. General information

NPI: 1528206026
Provider Name (Legal Business Name): DIMPY GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

IV. Provider business mailing address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-7200
  • Fax: 914-699-0837
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT-190188
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number269999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: