Provider Demographics
NPI:1548466402
Name:GREAT NECK MEDICAL PSYCHIATRY ASSOCIATES, PC
Entity type:Organization
Organization Name:GREAT NECK MEDICAL PSYCHIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADARSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-336-2544
Mailing Address - Street 1:1010 NORTHERN BLVD
Mailing Address - Street 2:SUITE 208D
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5306
Mailing Address - Country:US
Mailing Address - Phone:516-336-2544
Mailing Address - Fax:516-684-9536
Practice Address - Street 1:1010 NORTHERN BLVD
Practice Address - Street 2:SUITE 208D
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5306
Practice Address - Country:US
Practice Address - Phone:516-336-2544
Practice Address - Fax:516-684-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty