Healthcare Provider Details

I. General information

NPI: 1932154762
Provider Name (Legal Business Name): GUPTA INSTITUTE FOR PAIN, WELLNESS AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPRINGDALE RD STE B5
CHERRY HILL NJ
08003-3366
US

IV. Provider business mailing address

100 SPRINGDALE RD STE B5
CHERRY HILL NJ
08003-3366
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-7246
  • Fax: 856-482-7245
Mailing address:
  • Phone: 856-482-7246
  • Fax: 856-482-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25 MA 07713800
License Number StateNJ

VIII. Authorized Official

Name: RAJAN S GUPTA
Title or Position: DIRECTOR
Credential: MD
Phone: 856-482-7246