Provider Demographics
NPI:1659337285
Name:GUPTA, MOHINDER (MD)
Entity Type:Individual
Prefix:
First Name:MOHINDER
Middle Name:
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 1:89-06 135TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-206-6984
Mailing Address - Fax:718-206-6786
Practice Address - Street 1:4500 PARSONS BLVD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-5486
Practice Address - Fax:718-670-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108186207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00190978Medicaid
NY0105RYMedicare ID - Type Unspecified
NY00190978Medicaid