Provider Demographics
NPI:1336180272
Name:KALPANA ARYA-GUPTA PHYSICIAN P.C.
Entity Type:Organization
Organization Name:KALPANA ARYA-GUPTA PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYA-GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-326-0400
Mailing Address - Street 1:200 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7554 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2639
Practice Address - Country:US
Practice Address - Phone:718-326-0400
Practice Address - Fax:516-656-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202517174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07271Medicare ID - Type Unspecified
NY38A91Medicare ID - Type Unspecified