Basic Information
| Provider Information | |||||||||
| NPI: | 1437382413 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JAGDISH K. GUPTA M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 BERKELEY PL | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112173801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186383150 | ||||||||
| FaxNumber: | 7186384033 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 BERKELEY PL | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112173801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186383150 | ||||||||
| FaxNumber: | 7186384033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | JAGDISH | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7186383150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 123886 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.