Healthcare Provider Details

I. General information

NPI: 1790662310
Provider Name (Legal Business Name): MANVI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 POCONO RD OFC 2ND
DENVILLE NJ
07834-2954
US

IV. Provider business mailing address

25 POCONO RD OFC 2ND
DENVILLE NJ
07834-2954
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-4661
  • Fax: 973-365-4848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: