Provider Demographics
NPI:1023256567
Name:GUPTA, KUNAL (MD,,MBA)
Entity type:Individual
Prefix:DR
First Name:KUNAL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD,,MBA
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Other - Credentials:
Mailing Address - Street 1:222 SCHANCK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3068
Mailing Address - Country:US
Mailing Address - Phone:732-577-1999
Mailing Address - Fax:732-845-5356
Practice Address - Street 1:222 SCHANCK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3068
Practice Address - Country:US
Practice Address - Phone:732-577-1999
Practice Address - Fax:732-845-5356
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09114000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ240774OtherNJ MEDICARE
1023256567OtherNPI