Provider Demographics
NPI:1275516338
Name:GUPTA, VISHAL (MD)
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1184 5TH AVE
Mailing Address - Street 2:BOX 1236
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:212-241-7818
Mailing Address - Fax:212-410-7194
Practice Address - Street 1:1184 5TH AVE
Practice Address - Street 2:BOX 1236
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-241-7818
Practice Address - Fax:212-410-7194
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA903072085R0001X
NY2523612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology