1073569232 NPI number — VINOD K GUPTA MD

Table of content: VINOD K GUPTA MD (NPI 1073569232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073569232 NPI number — VINOD K GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
VINOD
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073569232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 PROSPECT AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-2565
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-2565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  1-194179 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01593360 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000401540001 . This is a "BS OF NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10000824 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30652 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805872 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1349211 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426007287 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P920287 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0061801 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195191 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 277682 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com