Provider Demographics
NPI:1629101613
Name:YKG MEDICAL P.C.
Entity Type:Organization
Organization Name:YKG MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-5080
Mailing Address - Street 1:1444 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SETON HALL STE 201A
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-272-5080
Mailing Address - Fax:518-272-5085
Practice Address - Street 1:1444 MASSACHUSETTS AVENUE
Practice Address - Street 2:SETON HALL STE. 201A
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-272-5080
Practice Address - Fax:518-272-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07030369Medicaid
NY00730369Medicaid
NY00569104Medicaid
NY00569104Medicaid
NY07030369Medicaid
NYE15449Medicare UPIN
NYB80644Medicare UPIN
NY51471AMedicare PIN