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NPI Code Detail

MEDICARE: DIVINITY MEDICAL SERVICES PLLC

MEDICARE: DIVINITY MEDICAL SERVICES PLLC
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
1261QU0200XUrgent Care Clinic/Center197245NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21902891393OTHERNYNPI

General Provider Information

NPI Number : 1497159560
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINITY MEDICAL SERVICES PLLC
Provider Business Mailing Address
First Line : 3091 CHEN CT
Second Line :
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-1972
Country : US
Telephone Number : 914-844-9803
Fax Number : 914-930-5551
Provider Business Practice Location Address
First Line : 3379 CROMPOND RD
Second Line :
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-3605
Country : US
Telephone Number : 914-844-9803
Fax Number : 914-930-5551
Authorized Official
Title or Position : DIRECTOR
Name : DR. RAJESH GUPTA
Credential : M.D.
Telephone Number : 914-930-5550
Provider Enumeration Date : 10/17/2014
Last Update Date : 02/18/2025

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1316511488 — DIVINITY MEDICAL SERVICES PLLC
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Practice Fax: 914-930-5551

Directions to “DIVINITY MEDICAL SERVICES PLLC ” Practice Location

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