Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MA07713800 | NJ |
NPI | 1114997962 |
---|---|
Provider Name | Dr. Rajan Gupta |
First Address | Cherry Hill, NJ 08003-3366 |
Second Address | Cherry Hill, NJ 08003-3366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H88074 | (02) |