Provider Demographics
NPI:1811036429
Name:SINDHU GUPTA, MD,PC
Entity Type:Organization
Organization Name:SINDHU GUPTA, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SINDHU
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-822-2138
Mailing Address - Street 1:1624 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5201
Mailing Address - Country:US
Mailing Address - Phone:718-822-2138
Mailing Address - Fax:718-822-6515
Practice Address - Street 1:1624 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5201
Practice Address - Country:US
Practice Address - Phone:718-822-2138
Practice Address - Fax:718-822-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174556207R00000X
NY218854207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356150Medicaid
NY01085556Medicaid
NY31E951Medicare ID - Type UnspecifiedDR. GUPTA
NYA62112Medicare UPIN
NY01085556Medicaid
NY02356150Medicaid