Prem P Gupta, MD
Individual provider Active NPI Neurology Physician · Ferndale, NY
NPI 1295706281 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1295706281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 140866 (NY)
- Practice address
- 39 Old Monticello Rd
Ferndale, NY 12734-5224 - Phone
- (845) 292-4560
- Fax
- (845) 292-4561
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060615000067 | NY | Practitioner - Neurology | 1254343189 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140866 | NY | MD | Neurology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 140866 | NY | Yes |
Addresses
Primary practice location
39 Old Monticello Rd
Ferndale, NY 12734-5224
Mailing address
39 Old Monticello Rd
Ferndale, NY 12734-5224
Phone (845) 292-4560
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00715242 | Medicaid | NY |
NPI Registry JSON
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1295706281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 OLD MONTICELLO RD",
"city": "FERNDALE",
"state": "NY",
"postal_code": "127345224",
"telephone_number": "845-292-4560",
"fax_number": "845-292-4561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39 OLD MONTICELLO RD",
"city": "FERNDALE",
"state": "NY",
"postal_code": "127345224",
"telephone_number": "845-292-4560",
"fax_number": "845-292-4561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "PREM",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "140866",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00715242",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
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All providers in Ferndale, NY · Neurology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.