Provider Demographics
NPI:1831166206
Name:GUPTA, BRIJENDRA KUMAR (MD)
Entity type:Individual
Prefix:
First Name:BRIJENDRA
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-433-0531
Mailing Address - Fax:716-433-8446
Practice Address - Street 1:6713 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-433-0531
Practice Address - Fax:716-433-8446
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0109980OtherINDEPENDENT HEALTH
NY00627069Medicaid
000508042001OtherBCBS OF WNY
00010070501OtherUNIVERA
00010070501OtherUNIVERA
B36125Medicare UPIN