Healthcare Provider Details

I. General information

NPI: 1528677317
Provider Name (Legal Business Name): NEHA GUPTA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35-37 PROGRESS ST STE A1
EDISON NJ
08820-1179
US

IV. Provider business mailing address

35-37 PROGRESS ST STE A1
EDISON NJ
08820-1179
US

V. Phone/Fax

Practice location:
  • Phone: 484-469-0852
  • Fax:
Mailing address:
  • Phone: 484-469-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NEHA GUPTA
Title or Position: OWNER
Credential: MD
Phone: 484-469-0852