Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 030257 | NY |
NPI | 1770895500 |
---|---|
Provider Name | Deepika Thakur-Gupta |
First Address | New York, NY 10016-4356 |
Second Address | New York, NY 10036-4005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12421185 | CAQH (01) | NY |