Provider Demographics
NPI:1730289679
Name:GULATI, GURJEET (MD)
Entity Type:Individual
Prefix:
First Name:GURJEET
Middle Name:
Last Name:GULATI
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 1:20 GRAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3901
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:33 GERMONDS ROAD
Practice Address - Street 2:
Practice Address - City:NEWCITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3555
Practice Address - Country:US
Practice Address - Phone:845-624-2748
Practice Address - Fax:845-624-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1986012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY237851OtherMEDICARE NUMBER