# GAYATRI GUPTA PHYSICIAN PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215160338
- **Authorized official:** HANAN WAIZMAN (BILLING)
- **Authorized official phone:** (845) 362-8100

## Contact information

- **Practice address:** 11 CRYSTAL SPRING RD, CHAPPAQUA, NY 10514-1412
- **Practice address phone:** (845) 362-8100
- **Mailing address:** 11 CRYSTAL SPRING RD, CHAPPAQUA, NY 10514-1412
- **Mailing address phone:** (845) 362-8100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 183714 | NY | Yes |

## Other

- **Enumeration date:** 08/25/2009
- **Last updated:** 08/25/2009