Provider Demographics
NPI:1245200963
Name:ANJALI R. GUPTA, M.D. P.C.
Entity Type:Organization
Organization Name:ANJALI R. GUPTA, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-9100
Mailing Address - Street 1:769 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1198
Mailing Address - Country:US
Mailing Address - Phone:973-736-9100
Mailing Address - Fax:973-736-9330
Practice Address - Street 1:769 NORTHFIELD AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1198
Practice Address - Country:US
Practice Address - Phone:973-736-9100
Practice Address - Fax:973-736-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07665900261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH00624Medicare UPIN
095125UPAMedicare ID - Type Unspecified