Provider Demographics
NPI:1396826467
Name:GUPTA, SADHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SADHANA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11506 BEACH CHANNEL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2206
Mailing Address - Country:US
Mailing Address - Phone:718-474-7744
Mailing Address - Fax:718-474-7755
Practice Address - Street 1:11506 BEACH CHANNEL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2206
Practice Address - Country:US
Practice Address - Phone:718-474-7744
Practice Address - Fax:718-474-7755
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH09419Medicare UPIN