MEDICARE: DR. PAYEL GUPTA MD

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	246978	NY
2	207R00000X	Internal Medicine Physician	246978	NY
3	208000000X	Pediatrics Physician	246978	NY

General Provider Information

NPI Number	:	1457533077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYEL GUPTA MD

Provider Business Mailing Address
First Line	:	419 CARLTON AVE APT B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3859
Country	:	US
Telephone Number	:	517-449-2644
Fax Number	:	517-201-2009

Provider Business Practice Location Address
First Line	:	586 PRESIDENT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2034
Country	:	US
Telephone Number	:	517-568-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	02/05/2026

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