Healthcare Provider Details

I. General information

NPI: 1780187559
Provider Name (Legal Business Name): GITANJALI C GUPTAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DAVENPORT AVE APT 3L
NEW ROCHELLE NY
10805-3664
US

IV. Provider business mailing address

50 DAVENPORT AVE APT 3L
NEW ROCHELLE NY
10805-3664
US

V. Phone/Fax

Practice location:
  • Phone: 917-497-4274
  • Fax:
Mailing address:
  • Phone: 917-497-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number691651-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: