Individual
GAUTAM GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 BOULEVARD, PASSAIC, NJ 07055-2840
(973) 365-4000
Mailing address
1122 53RD ST APT 507, NORTH BERGEN, NJ 07047-3158
(240) 408-6889
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA10368900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2015
Last updated
03/26/2021
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