1245331057 NPI number — URMIL R GUPTA MD

Table of content: URMIL R GUPTA MD (NPI 1245331057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245331057 NPI number — URMIL R GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
URMIL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1245331057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 ROUTE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10589-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-617-8402
Provider Business Mailing Address Fax Number:
914-617-8406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 ROUTE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10589-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-617-8402
Provider Business Practice Location Address Fax Number:
914-617-8406
Provider Enumeration Date:
09/26/2006

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: 207RG0300X , with the licence number:  1458381 , 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: 0027463 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0027463 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00764672 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CIM1458389 . This is a "WORKMENS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11000861 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42583 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94A871 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 117024 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: SP004 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0060341 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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