Provider Demographics
NPI:1740847391
Name:INDRANIL GUPTA, PHYSICIAN, PC
Entity type:Organization
Organization Name:INDRANIL GUPTA, PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDRANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-626-4881
Mailing Address - Street 1:3187 STEINWAY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3952
Mailing Address - Country:US
Mailing Address - Phone:718-626-4881
Mailing Address - Fax:
Practice Address - Street 1:3187 STEINWAY ST STE 6
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3952
Practice Address - Country:US
Practice Address - Phone:718-626-4881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty