Provider Demographics
NPI:1063824621
Name:GUPTA, ANU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BERKELEY PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3801
Mailing Address - Country:US
Mailing Address - Phone:718-638-3150
Mailing Address - Fax:718-638-4033
Practice Address - Street 1:207 BERKELEY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3801
Practice Address - Country:US
Practice Address - Phone:718-638-3150
Practice Address - Fax:718-638-4033
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222268-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine