| Sanjeev And Mukta Gupta | |
|
31 Hospital Dr Massena NY 13662 | |
| (315) 769-1099 | |
| (315) 769-1077 |
| Full Name | Sanjeev And Mukta Gupta |
|---|---|
| Speciality | Clinic/Center |
| Location | 31 Hospital Dr, Massena, New York |
| Authorized Official Name and Position | Sanjeev Gipta (OWNER) |
| Authorized Official Contact | 3157691099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanjeev And Mukta Gupta 31 Hospital Dr Massena NY 13662 Ph: (315) 769-1099 | Sanjeev And Mukta Gupta 31 Hospital Dr Massena NY 13662 Ph: (315) 769-1099 |
| NPI Number | 1245253830 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2961406434 |
|---|---|
| Medicare Enrollment ID | O20060914000456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245253830 | NPI | - | NPPES |
| 02224564 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 226022 (New York) | Primary |
| Provider Name | Mukta Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689673873 PECOS PAC ID: 9032113501 Enrollment ID: I20100728000163 |
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