Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 40304 | KY |
N | 2080P0203X | Pediatric Critical Care Doctor | 40304 | KY |
Y | 2080P0203X | Pediatric Critical Care Doctor | MA08858200 | NJ |
NPI | 1134270846 |
---|---|
Provider Name | Monika Gupta |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 17/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200883380 | (05) | IN |
7100018740 | (05) | KY |
MA08858200 | STATE LICENSE (01) | NJ |