Provider Demographics
NPI:1710437876
Name:GUPTA, MAHESH (PT)
Entity Type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PALISADE AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1135
Mailing Address - Country:US
Mailing Address - Phone:201-685-4969
Mailing Address - Fax:
Practice Address - Street 1:74 PALISADE AVE
Practice Address - Street 2:APT 6
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1135
Practice Address - Country:US
Practice Address - Phone:201-685-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist