Provider Demographics
NPI:1437309051
Name:ADITI GUPTA M D P A
Entity Type:Organization
Organization Name:ADITI GUPTA M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-752-3355
Mailing Address - Street 1:250 STELTON RD
Mailing Address - Street 2:SUITE # 3, LOR LYN PLAZA
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3285
Mailing Address - Country:US
Mailing Address - Phone:732-752-3355
Mailing Address - Fax:831-536-1696
Practice Address - Street 1:250 STELTON RD
Practice Address - Street 2:SUITE # 3, LOR LYN PLAZA
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3285
Practice Address - Country:US
Practice Address - Phone:732-752-3355
Practice Address - Fax:831-536-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04120200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
472995Medicare PIN