Provider Demographics
NPI:1407138639
Name:GUPTA, NIDHI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
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:SUNY @ STONY BROOK, DEPT OF NEUROLOGY
Mailing Address - Street 2:HEALTH SCIENCE CENTER T12-020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8121
Mailing Address - Country:US
Mailing Address - Phone:631-444-7878
Mailing Address - Fax:631-632-2451
Practice Address - Street 1:SUNY @ STONY BROOK, DEPT OF NEUROLOGY
Practice Address - Street 2:HEALTH SCIENCE CENTER T12-020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8121
Practice Address - Country:US
Practice Address - Phone:631-444-7878
Practice Address - Fax:631-632-2451
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2023-06-12
Deactivation Date:2021-06-17
Deactivation Code:
Reactivation Date:2021-07-12
Provider Licenses
StateLicense IDTaxonomies
MDD805782084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program