Healthcare Provider Details

I. General information

NPI: 1538226980
Provider Name (Legal Business Name): NEETI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A PRINCETON HIGHTSTOWN RD SUITE 203
EAST WINDSOR NJ
08520-1421
US

IV. Provider business mailing address

300A PRINCETON HIGHTSTOWN RD SUITE 203
EAST WINDSOR NJ
08520-1421
US

V. Phone/Fax

Practice location:
  • Phone: 609-371-6222
  • Fax: 609-371-6282
Mailing address:
  • Phone: 609-371-6222
  • Fax: 609-371-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number25MA07790300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA07790300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: