Healthcare Provider Details

I. General information

NPI: 1144724162
Provider Name (Legal Business Name): KAVITA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 900
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-9600
  • Fax: 646-962-0715
Mailing address:
  • Phone: 646-962-9600
  • Fax: 646-962-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number323959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: