MEDICARE: RAKESH GUPTA MEDICAL 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	174400000X	Specialist	148223	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CB6578	OTHER	NY	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00105544	OTHER	NY	PALMETTO GBA
4	P00049307	OTHER	NY	PALMETTO GBA
6	CB6577	OTHER	NY	RAILROAD MEDCIARE

General Provider Information

NPI Number	:	1407944564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAKESH GUPTA MEDICAL P.C.

Provider Business Mailing Address
First Line	:	238 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3627
Country	:	US
Telephone Number	:	718-327-2555
Fax Number	:	718-327-9319

Provider Business Practice Location Address
First Line	:	834 GLENRIDGE AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3019
Country	:	US
Telephone Number	:	718-327-2555
Fax Number	:	718-327-9319

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MR. NEVILLE GUPTA I
Credential	:
Telephone Number	:	718-372-7434

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/06/2008

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