Provider Demographics
NPI:1407944564
Name:RAKESH GUPTA MEDICAL P.C.
Entity Type:Organization
Organization Name:RAKESH GUPTA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:718-372-7434
Mailing Address - Street 1:238 BEACH 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3627
Mailing Address - Country:US
Mailing Address - Phone:718-327-2555
Mailing Address - Fax:718-327-9319
Practice Address - Street 1:834 GLENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3019
Practice Address - Country:US
Practice Address - Phone:718-327-2555
Practice Address - Fax:718-327-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00704036Medicaid
NY02533939Medicaid
NYP00105544OtherPALMETTO GBA
NYP00049307OtherPALMETTO GBA
NYCB6578OtherRAILROAD MEDICARE
NYCB6577OtherRAILROAD MEDCIARE
NYCB6578OtherRAILROAD MEDICARE
NY60A632Medicare PIN
10750Medicare PIN