Provider Demographics
NPI:1902037047
Name:GUPTA, MRINALI PATEL (MD)
Entity Type:Individual
Prefix:
First Name:MRINALI
Middle Name:PATEL
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MRINALI
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1305 YORK AVENUE- 11TH FLOOR
Mailing Address - Street 2:WEILL CORNELL MEDICAL COLLEGE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-962-2020
Mailing Address - Fax:646-962-0600
Practice Address - Street 1:1305 YORK AVENUE- 11TH FLOOR
Practice Address - Street 2:WEILL CORNELL MEDICAL COLLEGE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:646-962-2020
Practice Address - Fax:646-962-0600
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology