Individual
DEEPTI GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 MEDICAL DR, STE D, PORT JEFFERSON STATION, NY 11776-1598
(631) 331-5010
(631) 331-5017
Mailing address
2 MEDICAL DR, STE D, PORT JEFFERSON STATION, NY 11776-1598
(631) 331-5010
(631) 331-5017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196816
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01593246
—
NY
Enumeration date
03/22/2006
Last updated
07/03/2017
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