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General NPI Number Information
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NPI Number | 1740894906
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Entity Type | Individual
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Provider Name | NIDHI GUPTA M.D
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 225 COMMUNITY DRIVE, SUITE 110
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-918-4802
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Fax | 516-918-4839
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Provider Business Mailing Address
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Address Line | 225 COMMUNITY DRIVE, SUITE 110
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 646-714-5096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 338414
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 338414
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License Number State | NY
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