Provider Demographics
NPI:1366495780
Name:GUPTA, RAKESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:KUMAR
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 1:11312 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3953
Mailing Address - Country:US
Mailing Address - Phone:718-592-2626
Mailing Address - Fax:718-592-6910
Practice Address - Street 1:10555 62ND DR
Practice Address - Street 2:SUITE 1- H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1101
Practice Address - Country:US
Practice Address - Phone:718-592-2626
Practice Address - Fax:718-592-6910
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098593Medicaid
NY2589768-PPOOtherGHI
NM2795246OtherOXFORD
NY2382S1OtherEMPIRE BLUE CROSS/BLUE SH
NM2795246OtherOXFORD
NY07384GMedicare ID - Type Unspecified