Organization
SANJEEV AND MUKTA GUPTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJEEV GIPTA MD (OWNER)
(315) 769-1099
Entity
Organization
Contact information
Practice address
31 HOSPITAL DR, MASSENA, NY 13662
(315) 769-1099
(315) 769-1077
Mailing address
31 HOSPITAL DR, MASSENA, NY 13662
(315) 769-1099
(315) 769-1077
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
226022
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02224564
—
NY
Enumeration date
07/25/2006
Last updated
08/22/2020
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