Basic Information
| Provider Information | |||||||||
| NPI: | 1902037047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | MRINALI | ||||||||
| MiddleName: | PATEL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PATEL | ||||||||
| OtherFirstName: | MRINALI | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1305 YORK AVENUE- 11TH FLOOR | ||||||||
| Address2: | WEILL CORNELL MEDICAL COLLEGE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 YORK AVENUE- 11TH FLOOR | ||||||||
| Address2: | WEILL CORNELL MEDICAL COLLEGE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 269318 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.