Provider Demographics
NPI:1528483658
Name:KAUR, GURPREET (PA-C)
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 80TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1234
Mailing Address - Country:US
Mailing Address - Phone:718-886-9000
Mailing Address - Fax:
Practice Address - Street 1:4161 KISSENA BLVD
Practice Address - Street 2:5A CONCOURSE LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3181
Practice Address - Country:US
Practice Address - Phone:718-886-9000
Practice Address - Fax:718-961-0666
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017384363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400101305Medicare PIN
NY04536Medicare PIN