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General NPI Number Information
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NPI Number | 1578710588
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Entity Type | Organization
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Legal Business Name | ADVENT MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 6860 AUSTIN ST SUITE 303
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City | FOREST HILLS
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State | NY
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Zip | 11375-4245
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Country | US
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Telephone | 718-897-0008
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Fax | 718-897-1002
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Provider Business Mailing Address
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Address Line | 322 W 57TH ST APT 50U
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City | NEW YORK
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State | NY
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Zip | 10019-3701
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Country | US
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Telephone | 718-897-0008
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Fax | 718-897-1002
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NINA GUPTA
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Credential | M.D.
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Telephone | 718-897-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 186054
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License Number State | NY
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