Provider Demographics
NPI:1275026635
Name:KINGSBRIDGE MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:KINGSBRIDGE MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-688-4590
Mailing Address - Street 1:5546 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5250
Mailing Address - Country:US
Mailing Address - Phone:917-688-4590
Mailing Address - Fax:917-688-4591
Practice Address - Street 1:5546 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5250
Practice Address - Country:US
Practice Address - Phone:917-688-4590
Practice Address - Fax:917-688-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care