Healthcare Provider Details

I. General information

NPI: 1316511488
Provider Name (Legal Business Name): DIVINITY MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3605
US

IV. Provider business mailing address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3605
US

V. Phone/Fax

Practice location:
  • Phone: 914-930-5550
  • Fax: 914-930-5551
Mailing address:
  • Phone: 914-930-5550
  • Fax: 914-930-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJESH GUPTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 914-242-8318