MEDICARE: ANIL GUPTA,M.D.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	174785	NY
2	207KA0200X	Allergy Physician	174785	NY
3	2080P0201X	Pediatric Allergy/Immunology Physician	174785	NY
4	208000000X	Pediatrics Physician	174785	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265628184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANIL GUPTA,M.D.,P.C.

Provider Business Mailing Address
First Line	:	1624 CROSBY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5201
Country	:	US
Telephone Number	:	718-822-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 CROSBY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5201
Country	:	US
Telephone Number	:	718-822-0676
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANIL GUPTA
Credential	:	M.D.
Telephone Number	:	718-822-0676

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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