Provider Demographics
NPI:1972887891
Name:GUPTA, SUNEEPA
Entity Type:Individual
Prefix:
First Name:SUNEEPA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108-136 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:APT 1312-B
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-5348
Mailing Address - Country:US
Mailing Address - Phone:201-598-4385
Mailing Address - Fax:
Practice Address - Street 1:108-136 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:APT 1312-B
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-5348
Practice Address - Country:US
Practice Address - Phone:201-598-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031498-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist