| Prem Prakash Gupta M.d P.c | |
|
39 Old Monticello Rd Ferndale NY 12734-5224 | |
| (845) 292-4560 | |
| (845) 292-4561 |
| Full Name | Prem Prakash Gupta M.d P.c |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 39 Old Monticello Rd, Ferndale, New York |
| Authorized Official Name and Position | Prem Prakash Gupta (PRESIDENT) |
| Authorized Official Contact | 8452924560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prem Prakash Gupta M.d P.c 39 Old Monticello Rd Ferndale NY 12734-5224 Ph: (845) 292-4560 | Prem Prakash Gupta M.d P.c 39 Old Monticello Rd Ferndale NY 12734-5224 Ph: (845) 292-4560 |
| NPI Number | 1013943141 |
|---|---|
| Provider Enumeration Date | 06/23/2006 |
| Last Update Date | 10/10/2007 |
| Medicare PECOS PAC ID | 8224040415 |
|---|---|
| Medicare Enrollment ID | O20060710000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013943141 | NPI | - | NPPES |
| 00715242 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 140866 (New York) | Primary |
| Provider Name | Prem P Gupta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295706281 PECOS PAC ID: 1254343189 Enrollment ID: I20060615000067 |
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