Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 174785 | NY |
N | 208000000X | Pediatrician | 174785 | NY |
N | 2080P0201X | Pediatric Allergist | 174785 | NY |
NPI | 1154325694 |
---|---|
Provider Name | Anil Gupta |
First Address | Bronx, NY 10461-5201 |
Second Address | Bronx, NY 10461-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 15/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015730 | GHI (01) | NM |
01136034 | (05) | NY |
1000001124 | AFFINITY (ALLERGY) (01) | NM |
11373P | HIP (01) | NM |
119283 | WELLCARE (ALLERGY) (01) | NY |
12-02734 | UNITED HEALTHCARE (01) | NY |
29747P | HIP (RANDALL AVENUE) (01) | NY |
2C3324 | HEALTHNET (01) | NM |
316710101 | HEALTHPLUS (PEDS/RANDALL) (01) | NY |
316770102 | HEALTHPLUS (CROSBY) (01) | NY |
4132111 | AETNA USHC (01) | NY |
54940C | CIGNA (01) | NY |
60402280 | FIDELIS (PEDS/RANDALL) (01) | NY |
60402281 | FIDELIS (ALLERGY) (01) | NY |
6040228C | FIDELIS (PEDS/CROSBY) (01) | NY |
D92246 | (02) | |
GP258 | OXFORD (01) |