Provider Demographics
NPI:1538117999
Name:GUPTA, SANJAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 OLD NEW MILFORD RD
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2430
Mailing Address - Country:US
Mailing Address - Phone:203-775-6205
Mailing Address - Fax:203-775-2373
Practice Address - Street 1:60 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 3G
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-775-6205
Practice Address - Fax:203-775-2373
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYP39592207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT33073OtherCONNECTICUT LICENSE