Provider Demographics
NPI:1558472241
Name:GUPTA, VINOD K (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3681 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2674
Mailing Address - Country:US
Mailing Address - Phone:732-863-7100
Mailing Address - Fax:732-863-7001
Practice Address - Street 1:3681 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2674
Practice Address - Country:US
Practice Address - Phone:732-863-7100
Practice Address - Fax:732-863-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA56132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD46677Medicare UPIN