Provider Demographics
NPI:1336118975
Name:GUPTA, PUNIT K (MD)
Entity Type:Individual
Prefix:DR
First Name:PUNIT
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 POMPTON AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1814
Mailing Address - Country:US
Mailing Address - Phone:973-779-5879
Mailing Address - Fax:973-239-4267
Practice Address - Street 1:388 POMPTON AVE
Practice Address - Street 2:STE 4
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1814
Practice Address - Country:US
Practice Address - Phone:973-779-5879
Practice Address - Fax:973-239-4267
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072171207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036323Medicaid
NJ081625Medicare ID - Type Unspecified
NJ0036323Medicaid