Healthcare Provider Details

I. General information

NPI: 1962694307
Provider Name (Legal Business Name): PRIYANKA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410-18 BROADWAY 2ND FLOOR
NEW YORK NY
10031
US

IV. Provider business mailing address

3410 BROADWAY 2ND FLOOR
NEW YORK NY
10031
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-2099
  • Fax: 212-234-2939
Mailing address:
  • Phone: 212-283-2099
  • Fax: 212-234-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number002876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: