Provider Demographics
NPI:1841353851
Name:GUPTE, ANJALI P (RD,MSCDN)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:P
Last Name:GUPTE
Suffix:
Gender:F
Credentials:RD,MSCDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LARISSA CT
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3833
Mailing Address - Country:US
Mailing Address - Phone:845-426-1136
Mailing Address - Fax:
Practice Address - Street 1:3 LARISSA CT
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3833
Practice Address - Country:US
Practice Address - Phone:845-426-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS03062Medicare ID - Type UnspecifiedMCARE IID