Provider Demographics
NPI:1396749214
Name:GUPTA, SAROJ (MD)
Entity type:Individual
Prefix:
First Name:SAROJ
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18016 WEXFORD TER
Mailing Address - Street 2:STE CB
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3004
Mailing Address - Country:US
Mailing Address - Phone:718-658-5639
Mailing Address - Fax:718-865-9108
Practice Address - Street 1:18016 WEXFORD TER
Practice Address - Street 2:STE CB
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3004
Practice Address - Country:US
Practice Address - Phone:718-658-5639
Practice Address - Fax:718-865-9108
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY150180208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY87402Medicare ID - Type Unspecified