Provider Demographics
NPI:1093782559
Name:GUPTA, YOGESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:YOGESH
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1600
Mailing Address - Country:US
Mailing Address - Phone:518-272-5080
Mailing Address - Fax:518-272-5085
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-272-5080
Practice Address - Fax:518-272-5085
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07030369Medicaid
NY51471BMedicare ID - Type Unspecified
NY51471BMedicare ID - Type UnspecifiedMEDICARE NUMBER
NY07030369Medicaid