Healthcare Provider Details

I. General information

NPI: 1902037047
Provider Name (Legal Business Name): MRINALI PATEL GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRINALI PATEL MD

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVENUE- 11TH FLOOR WEILL CORNELL MEDICAL COLLEGE
NEW YORK NY
10021
US

IV. Provider business mailing address

1305 YORK AVENUE- 11TH FLOOR WEILL CORNELL MEDICAL COLLEGE
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2020
  • Fax: 646-962-0600
Mailing address:
  • Phone: 646-962-2020
  • Fax: 646-962-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number269318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: