Provider Demographics
NPI:1568836039
Name:AMIT GUPTA PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:AMIT GUPTA PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-212-5074
Mailing Address - Street 1:16 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1427
Mailing Address - Country:US
Mailing Address - Phone:850-212-5074
Mailing Address - Fax:732-587-5486
Practice Address - Street 1:16 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1427
Practice Address - Country:US
Practice Address - Phone:850-212-5074
Practice Address - Fax:732-587-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09111800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty