Provider Demographics
NPI:1417941691
Name:GUPTA, PIYUSH M (MD)
Entity Type:Individual
Prefix:DR
First Name:PIYUSH
Middle Name:M
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 1:29 MCGUIRE DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1719
Mailing Address - Country:US
Mailing Address - Phone:973-325-8855
Mailing Address - Fax:973-243-9701
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-7189
Practice Address - Fax:718-635-7241
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183642207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01245129Medicaid
NY78F2124981Medicare PIN
NYE87549Medicare UPIN
NY78F211Medicare ID - Type Unspecified