Provider Demographics
NPI:1972774743
Name:GUPTA, PAYAL PATEL (MD)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:PATEL
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAYAL
Other - Middle Name:H
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:35 HUDSON ST
Mailing Address - Street 2:APT 1103
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:978-729-2723
Mailing Address - Fax:
Practice Address - Street 1:6740 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5252
Practice Address - Country:US
Practice Address - Phone:718-491-5822
Practice Address - Fax:718-491-7800
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0508042085B0100X
MA2389182085R0202X
NY2650342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging