Provider Demographics
NPI:1497023642
Name:NG PROF MGMT SOLUTIONS, LLC
Entity Type:Organization
Organization Name:NG PROF MGMT SOLUTIONS, LLC
Other - Org Name:NITYANAND D GUPTA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITYANAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-240-5696
Mailing Address - Street 1:2816 VEACH RD
Mailing Address - Street 2:STE 306
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6295
Mailing Address - Country:US
Mailing Address - Phone:270-240-5696
Mailing Address - Fax:270-240-5697
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:STE 306
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-240-5696
Practice Address - Fax:270-240-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty