Healthcare Provider Details

I. General information

NPI: 1497159560
Provider Name (Legal Business Name): DIVINITY MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3605
US

IV. Provider business mailing address

3091 CHEN CT
YORKTOWN HEIGHTS NY
10598-1972
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-9803
  • Fax: 914-930-5551
Mailing address:
  • Phone: 914-844-9803
  • Fax: 914-930-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number197245
License Number StateNY

VIII. Authorized Official

Name: DR. RAJESH GUPTA
Title or Position: DIRECTOR
Credential: M.D.
Phone: 914-930-5550