Healthcare Provider Details

I. General information

NPI: 1023256567
Provider Name (Legal Business Name): KUNAL GUPTA M.D.,,M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SCHANCK RD SUITE 302
FREEHOLD NJ
07728-3068
US

IV. Provider business mailing address

222 SCHANCK RD SUITE 302
FREEHOLD NJ
07728-3068
US

V. Phone/Fax

Practice location:
  • Phone: 732-577-1999
  • Fax: 732-845-5356
Mailing address:
  • Phone: 732-577-1999
  • Fax: 732-845-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA09114000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: