Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 25MA08156200 | NJ |
N | 2084N0600X | Clinical Neurophysiologist | 25MA08156200 | NJ |
NPI | 1477559763 |
---|---|
Provider Name | Divya Gupta |
First Address | Edison, NJ 08820-3947 |
Second Address | Edison, NJ 08820-3947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001401380 | (05) | CT |
0121622 | (05) | NJ |
130000567 | UCHC, FARMINGTON, CT (01) | |
130000575 | ECHN, MANCHESTER, CT (01) | |
H63119 | (02) |