Provider Demographics
NPI:1861490666
Name:GUPTA, PUNEET
Entity Type:Individual
Prefix:
First Name:PUNEET
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLOCK TOWER COMMONS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-279-5187
Mailing Address - Fax:
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:SUITE 209
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2223
Practice Address - Country:US
Practice Address - Phone:845-896-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC342422080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21269Medicare UPIN