Healthcare Provider Details

I. General information

NPI: 1649820614
Provider Name (Legal Business Name): WALK IN WOMENS GYNECOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CODDINGTON AVE
STATEN ISLAND NY
10306-4305
US

IV. Provider business mailing address

7001 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379-2191
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax:
Mailing address:
  • Phone: 917-410-6905
  • Fax: 646-878-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEETI GUPTA
Title or Position: CEO
Credential: MD
Phone: 917-410-6905