1205846904 NPI number — DR. ASHOK GUPTA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205846904 NPI number — DR. ASHOK GUPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
ASHOK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205846904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
842 CLIFTON AVE
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-470-0101
Provider Business Mailing Address Fax Number:
973-777-3024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
842 CLIFTON AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-470-0101
Provider Business Practice Location Address Fax Number:
973-777-3024
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  25MA03911600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101841000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K8630 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5V9742 . This is a "BC BS OF NY SUITE 102 W. PATERSON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0622800 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1945316 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4093605 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0414862 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5V9741 . This is a "BC BS OF NY 842 CLIFTON AVE." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3929798 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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