Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 233908 | NY |
NPI | 1659479897 |
---|---|
Provider Name | Dr. Sujata Gupta |
First Address | Forest Hills, NY 11375-2760 |
Second Address | Mineola, NY 11501-3957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02669783 | (05) | NY |
I38196 | (02) | NY |