Provider Demographics
NPI:1205846904
Name:GUPTA, ASHOK
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 CLIFTON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-470-0101
Mailing Address - Fax:973-777-3024
Practice Address - Street 1:842 CLIFTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-470-0101
Practice Address - Fax:973-777-3024
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03911600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0101841000OtherAMERIHEALTH
NJ3K8630OtherHEALTHNET
NJ5V9742OtherBC BS OF NY SUITE 102 W. PATERSON
NJ0622800Medicaid
NJ1945316OtherAETNA HMO
NJ4093605OtherAETNA PPO
NJ0414862OtherGHI PPO
NJ5V9741OtherBC BS OF NY 842 CLIFTON AVE.
NJP3929798OtherOXFORD
NJ5V9742OtherBC BS OF NY SUITE 102 W. PATERSON
NJ1945316OtherAETNA HMO
NJ444721Medicare PIN