Provider Demographics
NPI:1932302924
Name:GUPTA, SANCHITA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:SANCHITA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1396
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-967-0340
Practice Address - Street 1:190 DAYTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4422
Practice Address - Country:US
Practice Address - Phone:201-670-7800
Practice Address - Fax:201-670-7720
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2015-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09579800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ375312YXW7OtherMEDICARE PTAN