Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 25MA10853900 | NJ |
NPI | 1083024947 |
---|---|
Provider Name | Dr. Sanjeev Mohan Gupta |
First Address | Hackensack, NJ 07601-1749 |
Second Address | Hackensack, NJ 07601-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 27/07/2020 |