Organization
PREM PRAKASH GUPTA M.D P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PREM PRAKASH GUPTA M.D (PRESIDENT)
(845) 292-4560
Entity
Organization
Contact information
Practice address
39 OLD MONTICELLO RD, FERNDALE, NY 12734-5224
(845) 292-4560
(845) 292-4561
Mailing address
39 OLD MONTICELLO RD, FERNDALE, NY 12734-5224
(845) 292-4560
(845) 292-4561
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
140866
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00715242
—
NY
Enumeration date
06/23/2006
Last updated
10/10/2007
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