Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA09114000 | NJ |
NPI | 1023256567 |
---|---|
Provider Name | Dr. Kunal Gupta |
First Address | Freehold, NJ 07728-3068 |
Second Address | Freehold, NJ 07728-3068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2009 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023256567 | NPI (01) | |
240774 | NJ MEDICARE (01) | NJ |