Provider Demographics
NPI:1043264047
Name:GUPTA, SALIL (M D)
Entity Type:Individual
Prefix:
First Name:SALIL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 UNIVERSITY PL
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4515
Mailing Address - Country:US
Mailing Address - Phone:212-400-6633
Mailing Address - Fax:212-604-1379
Practice Address - Street 1:95 UNIVERSITY PL
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4515
Practice Address - Country:US
Practice Address - Phone:212-400-6633
Practice Address - Fax:212-604-1379
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218753207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133911727OtherTAX ID
NY088KF1OtherBLUE SHIELD
NY9J3081OtherBLUE SHIELD
NY1215981717OtherGROUP NPI
NY02735624Medicaid
NY133911727OtherTAX ID
NY07871Medicare ID - Type UnspecifiedQUEENS MEDICARE
NY1267390001Medicare NSC
NY088KF1OtherBLUE SHIELD