Basic Information
| Provider Information | |||||||||
| NPI: | 1831274315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | SANJEEV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 BLONDELL AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
| FaxNumber: | 7184308975 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 BLONDELL AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
| FaxNumber: | 7184308975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 174208 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 17428 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.