Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA09261300 | NJ |
N | 111NI0900X | Internist | 25MA09261300 | NJ |
Y | 207RG0300X | Geriatric Medicine | 25MA09261300 | NJ |
NPI | 1073833554 |
---|---|
Provider Name | Dr. Kavita Gupta |
First Address | Cedar Grove, NJ 07009-1814 |
Second Address | Cedar Grove, NJ 07009-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 01/04/2020 |