1821238676 NPI number — DR. GUNJAN GUPTA MD, PHD

Table of content: DR. GUNJAN GUPTA MD, PHD (NPI 1821238676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821238676 NPI number — DR. GUNJAN GUPTA MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
GUNJAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUPTA
Provider Other First Name:
GUNJAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821238676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 HOSPITAL AVE
Provider Second Line Business Mailing Address:
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810-6099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-864-4418
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-6099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-739-6471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2009

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: 207ZP0102X , with the licence number:  52359 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZH0000X , with the licence number: 52359 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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