Provider Demographics
NPI:1184664179
Name:GUPTA, MEENU (MD)
Entity Type:Individual
Prefix:
First Name:MEENU
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 1:10555 62ND DR
Mailing Address - Street 2:STE 1H
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1109
Mailing Address - Country:US
Mailing Address - Phone:718-263-5251
Mailing Address - Fax:718-849-3166
Practice Address - Street 1:10555 62ND DR
Practice Address - Street 2:STE 1H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1109
Practice Address - Country:US
Practice Address - Phone:718-849-2723
Practice Address - Fax:718-849-3166
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231047207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594916Medicaid
NY02594916Medicaid
NY06451Medicare ID - Type Unspecified