MEDICARE: DR. SANDEEP GULATI D.O.

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	2084N0400X	Neurology Physician	239956	NY

General Provider Information

NPI Number	:	1740292051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP GULATI D.O.

Provider Business Mailing Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2668
Country	:	US
Telephone Number	:	718-515-4347
Fax Number	:	718-653-8641

Provider Business Practice Location Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2668
Country	:	US
Telephone Number	:	718-515-4347
Fax Number	:	718-653-8641

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	02/23/2010

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