Healthcare Provider Details

I. General information

NPI: 1003041088
Provider Name (Legal Business Name): ANKUR GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E 29TH ST APT 5D
NEW YORK NY
10016-8577
US

IV. Provider business mailing address

226 E 29TH ST APT 5D
NEW YORK NY
10016-8577
US

V. Phone/Fax

Practice location:
  • Phone: 646-621-7240
  • Fax: 718-343-7463
Mailing address:
  • Phone: 646-621-7240
  • Fax: 718-343-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number047725
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: