Provider Demographics
NPI:1851548903
Name:SAROJ GUPTA MD
Entity Type:Organization
Organization Name:SAROJ GUPTA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAROJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-658-5639
Mailing Address - Street 1:18016 WEXFORD TER
Mailing Address - Street 2:SUITE CB
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3000
Mailing Address - Country:US
Mailing Address - Phone:718-658-5639
Mailing Address - Fax:718-657-5606
Practice Address - Street 1:18016 WEXFORD TER
Practice Address - Street 2:SUITE CB
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3000
Practice Address - Country:US
Practice Address - Phone:718-658-5639
Practice Address - Fax:718-657-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty