Basic Information
| Provider Information | |||||||||
| NPI: | 1003887258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUJADHUR | ||||||||
| FirstName: | NILI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 READE PL STE 1100 | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454740556 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9 LIVINGSTON ST | ||||||||
| Address2: | SUITE 4N | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454710232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 223139 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 223139 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02208400 | 05 | NY | MEDICAID |