Provider Demographics
NPI:1154325694
Name:GUPTA, ANIL (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:
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 1:1624 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5201
Mailing Address - Country:US
Mailing Address - Phone:718-822-0676
Mailing Address - Fax:718-822-6516
Practice Address - Street 1:1624 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5201
Practice Address - Country:US
Practice Address - Phone:718-822-0676
Practice Address - Fax:718-822-6516
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2015-09-15
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY1747852080P0201X, 207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1000001124OtherAFFINITY (ALLERGY)
NM11373POtherHIP
NY4132111OtherAETNA USHC
NY119283OtherWELLCARE (ALLERGY)
NY12-02734OtherUNITED HEALTHCARE
NM2C3324OtherHEALTHNET
NY54940COtherCIGNA
GP258OtherOXFORD
NY316710101OtherHEALTHPLUS (PEDS/RANDALL)
NM0015730OtherGHI
NY29747POtherHIP (RANDALL AVENUE)
NY01136034Medicaid
NY316770102OtherHEALTHPLUS (CROSBY)
NY60402280OtherFIDELIS (PEDS/RANDALL)
NY60402281OtherFIDELIS (ALLERGY)
NY6040228COtherFIDELIS (PEDS/CROSBY)
NY54940COtherCIGNA
NY01136034Medicaid