Healthcare Provider Details

I. General information

NPI: 1780553677
Provider Name (Legal Business Name): GAUTAM AHLUWALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 11/07/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4430
US

IV. Provider business mailing address

667 STONELEIGH AVE STE A201
CARMEL NY
10512-2454
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-3303
  • Fax: 914-962-4271
Mailing address:
  • Phone: 845-278-5223
  • Fax: 845-278-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number339937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: