Provider Demographics
NPI:1104030626
Name:DR RAKESH GUPTA-DR MEENU GUPTA MEDICAL PC
Entity Type:Organization
Organization Name:DR RAKESH GUPTA-DR MEENU GUPTA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-238-4235
Mailing Address - Street 1:11312 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3953
Mailing Address - Country:US
Mailing Address - Phone:516-488-0241
Mailing Address - Fax:
Practice Address - Street 1:10555 62ND DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1101
Practice Address - Country:US
Practice Address - Phone:516-238-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231047174400000X
NY218280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07384GMedicare PIN
07384HMedicare PIN