Provider Demographics
NPI:1629082896
Name:GUPTA, ANUJA (PHD)
Entity Type:Individual
Prefix:
First Name:ANUJA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DUNHILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2248
Mailing Address - Country:US
Mailing Address - Phone:516-384-7051
Mailing Address - Fax:
Practice Address - Street 1:23 DUNHILL RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2248
Practice Address - Country:US
Practice Address - Phone:516-384-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13216103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01809925Medicaid
NYV93061Medicare ID - Type Unspecified