Provider Demographics
NPI:1366451213
Name:GUPTA, NINA (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MRIDULA
Other - Middle Name:GUPTA
Other - Last Name:NOORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17885 COLLINS AVE UNIT 3603
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-916-1454
Mailing Address - Fax:718-897-1002
Practice Address - Street 1:20200 W. DIXIE HWY STE 808
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-934-9149
Practice Address - Fax:718-897-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186054207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01642433Medicaid
NY02289AMedicare PIN
NYG00610Medicare UPIN