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NPI Code Detail

MEDICARE: DR. SURENDRA KUMAR GUPTA MD

MEDICARE:  DR. SURENDRA KUMAR 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
1207RN0300XNephrology Physician113450NY

Other Identifiers

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

General Provider Information

NPI Number : 1629056338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SURENDRA KUMAR GUPTA MD
Provider Business Mailing Address
First Line : 1 HEMLOCK LN
Second Line :
City : ROSLYN HEIGHTS
State : NY
Zip : 11577-2703
Country : US
Telephone Number : 516-621-4296
Fax Number : 718-533-0264
Provider Business Practice Location Address
First Line : 3435 70TH ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-1055
Country : US
Telephone Number : 718-651-9700
Fax Number : 718-533-0264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 07/08/2007

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