Provider Demographics
NPI:1922344399
Name:GUPTA, RITU (APN)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0471
Mailing Address - Country:US
Mailing Address - Phone:609-483-6745
Mailing Address - Fax:
Practice Address - Street 1:513R RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2901
Practice Address - Country:US
Practice Address - Phone:609-483-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012623363LF0000X, 363L00000X
NJ26NJ00412800363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9609987OtherAETNA
NJ276462OtherMEDICARE PTAN
NJ0392961Medicaid
PA102788627Medicaid
NJ04088619OtherAMERIGROUP
NJP5489666OtherOXFORD