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General NPI Number Information
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NPI Number | 1497878581
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Entity Type | Organization
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Legal Business Name | GUPTA GASTRO ASSOCIATE OFFICE BASED SURGERY, P.C.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 130 AVENUE P
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City | BROOKLYN
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State | NY
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Zip | 11204-6362
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Country | US
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Telephone | 718-372-7434
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Fax | 718-266-2663
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Provider Business Mailing Address
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Address Line | 130 AVENUE P
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City | BROOKLYN
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State | NY
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Zip | 11204-6362
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Country | US
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Telephone | 718-372-7434
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. NEVILLE GUPTA
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Credential |
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Telephone | 718-372-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 148223
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License Number State | NY
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