Provider Demographics
NPI:1740568153
Name:SENGUPTA, VIKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:
Last Name:SENGUPTA
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 1:265 SUNRISE HWY STE 1-274
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4912
Mailing Address - Country:US
Mailing Address - Phone:212-803-3339
Mailing Address - Fax:646-768-8600
Practice Address - Street 1:555 LEFFERTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:212-803-3339
Practice Address - Fax:646-768-8600
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266344207R00000X
NY276713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04072482Medicaid