Healthcare Provider Details

I. General information

NPI: 1881422129
Provider Name (Legal Business Name): WELLNESS PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 5TH AVE
NEW YORK NY
10016-5038
US

IV. Provider business mailing address

325 5TH AVE APT 22H
NEW YORK NY
10016-5042
US

V. Phone/Fax

Practice location:
  • Phone: 646-355-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: VIKAS GUPTA
Title or Position: CEO
Credential: MD
Phone: 646-212-1906