1154325694 NPI number — ANIL GUPTA MD

Table of content: ANIL GUPTA MD (NPI 1154325694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154325694 NPI number — ANIL GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
ANIL
Provider Middle Name:
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:
1154325694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1624 CROSBY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-822-0676
Provider Business Mailing Address Fax Number:
718-822-6516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 CROSBY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-822-0676
Provider Business Practice Location Address Fax Number:
718-822-6516
Provider Enumeration Date:
06/13/2005

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: 2080P0201X , with the licence number:  174785 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 174785 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 174785 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1000001124 . This is a "AFFINITY (ALLERGY)" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 11373P . This is a "HIP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 4132111 . This is a "AETNA USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 119283 . This is a "WELLCARE (ALLERGY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12-02734 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C3324 . This is a "HEALTHNET" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 54940C . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: GP258 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 316710101 . This is a "HEALTHPLUS (PEDS/RANDALL)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0015730 . This is a "GHI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 29747P . This is a "HIP (RANDALL AVENUE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01136034 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 316770102 . This is a "HEALTHPLUS (CROSBY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 60402280 . This is a "FIDELIS (PEDS/RANDALL)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 60402281 . This is a "FIDELIS (ALLERGY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6040228C . This is a "FIDELIS (PEDS/CROSBY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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