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General NPI Number Information
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NPI Number | 1699961185
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Entity Type | Organization
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Legal Business Name | ASHA GUPTA, MD
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 260 RIVERSIDE DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2745
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Country | US
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Telephone | 607-798-7811
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Fax | 607-770-7035
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Provider Business Mailing Address
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Address Line | 260 RIVERSIDE DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2745
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Country | US
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Telephone | 607-798-7811
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Fax | 607-770-7035
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Authorized Official
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Title or Position | OFFFICE MANAGER
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Name | GWEN SPAULDING
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Credential | MEDICAL ASSISTANT
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Telephone | 607-798-7811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 124306
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License Number State | NY
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