Provider Demographics
NPI:1932391448
Name:VIJAY K. GUPTA, M.D.
Entity Type:Organization
Organization Name:VIJAY K. GUPTA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-779-1467
Mailing Address - Street 1:285 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-6308
Mailing Address - Country:US
Mailing Address - Phone:973-779-1467
Mailing Address - Fax:973-239-4267
Practice Address - Street 1:33 CLUB WAY
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2054
Practice Address - Country:US
Practice Address - Phone:973-779-1467
Practice Address - Fax:973-324-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2984202Medicaid
NJ2984202Medicaid