Provider Demographics
NPI:1770895500
Name:THAKUR-GUPTA, DEEPIKA (PT)
Entity type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:
Last Name:THAKUR-GUPTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK AVE APT 73
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4356
Mailing Address - Country:US
Mailing Address - Phone:917-860-6110
Mailing Address - Fax:
Practice Address - Street 1:115 W 45TH ST STE 301
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4005
Practice Address - Country:US
Practice Address - Phone:212-300-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0302572251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12421185OtherCAQH
NY46-1396412OtherEIN