Provider Demographics
NPI:1649820614
Name:WALK IN WOMENS GYNECOLOGY PLLC
Entity type:Organization
Organization Name:WALK IN WOMENS GYNECOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEETI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-410-6905
Mailing Address - Street 1:7001 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2191
Mailing Address - Country:US
Mailing Address - Phone:917-410-6905
Mailing Address - Fax:646-878-6095
Practice Address - Street 1:5 CODDINGTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4305
Practice Address - Country:US
Practice Address - Phone:917-410-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144422OtherLICENSE
NY293612OtherLICENSE
NY265081OtherLICENSE