Provider Demographics
NPI:1972682318
Name:GUPTA, ADITI (MD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STELTON RD
Mailing Address - Street 2:SUITE # 3 , LOR LYN PLAZA
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3285
Mailing Address - Country:US
Mailing Address - Phone:732-752-3355
Mailing Address - Fax:831-536-1696
Practice Address - Street 1:250 STELTON RD
Practice Address - Street 2:SUITE # 3 , LOR LYN PLAZA
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3285
Practice Address - Country:US
Practice Address - Phone:732-752-3355
Practice Address - Fax:831-536-1696
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472995Medicare PIN