Individual
GAUTAM SHARMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7218 164TH ST, FRESH MEADOWS, NY 11365-4222
(718) 969-6640
Mailing address
7218 164TH ST, FRESH MEADOWS, NY 11365-4222
(718) 969-6640
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
317425
NY
207Q00000X
Family Medicine Physician
OT019545
PA
Other
Enumeration date
06/27/2019
Last updated
10/03/2024
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