1922344399 NPI number — RITU GUPTA APN

Table of content: RITU GUPTA APN (NPI 1922344399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922344399 NPI number — RITU GUPTA APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
RITU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

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:
1922344399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 471
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THREE BRIDGES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08887-0471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-483-6745
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513R RARITAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08904-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-483-6745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2012

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: 363LF0000X , with the licence number:  SP012623 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 26NJ00412800 , 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: 9609987 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 276462 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0392961 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102788627 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04088619 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P5489666 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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