Healthcare Provider Details

I. General information

NPI: 1922144302
Provider Name (Legal Business Name): RAKESH GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAKESH P GUPTA M.D.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11428-1352
US

IV. Provider business mailing address

9033 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11428-1352
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-5225
  • Fax:
Mailing address:
  • Phone: 718-464-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number242000
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number242000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: