NPIMap

Organization Active NPI

Internal Medicine of West Haven LLC

  • Internal Medicine Physician
  • West Haven, CT
National Provider Identifier
1003005703
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE OF WEST HAVEN LLC
Practice address
764 Campbell Ave
Suite E
West Haven, CT 06516-3786
Phone
(203) 931-0034
Fax
(203) 931-8225
NPI assigned
Oct 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Piyush Gupta, MDNPI 1780945212
Title
Ceo
Phone
(203) 931-0034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

764 Campbell Ave
Suite E
West Haven, CT 06516-3786

Mailing address

764 Campbell Ave
West Haven, CT 06516-3786
Phone (203) 931-0034

Other practice location 1

245 Amity Rd Ste 108
Woodbridge, CT 06525-2256
Phone (203) 397-2227

Other identifiers 4

IdentifierTypeStateIssuer
008117274MedicaidCT
008080626MedicaidCT
008118533MedicaidCT
008119896MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060206000397 CT Part B Supplier - Clinic/Group Practice 3476567892 Receives reassigned benefits from 13 practitioners
Practice locations: West Haven, CT; Avon, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D1008034Internal Medicine of West Haven CT764 Campbell Avenue, West Haven, CT 06516Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ADDDAD

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1003005703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163786",
            "telephone_number": "203-931-0034",
            "fax_number": "203-931-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 CAMPBELL AVE",
            "address_2": "SUITE E",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163786",
            "telephone_number": "203-931-0034",
            "fax_number": "203-931-8225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 Amity Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "CT",
            "postal_code": "065252256",
            "country_code": "US",
            "telephone_number": "203-397-2227",
            "fax_number": "203-389-9313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERNAL MEDICINE OF WEST HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "PIYUSH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-931-0034",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008117274",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008080626",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008118533",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008119896",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.