Healthcare Provider Details

I. General information

NPI: 1730812728
Provider Name (Legal Business Name): ARCHANA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MADISON AVE
MORRISTOWN NJ
07960-7330
US

IV. Provider business mailing address

26 W 5TH ST
NEW PROVIDENCE NJ
07974-2212
US

V. Phone/Fax

Practice location:
  • Phone: 973-540-9800
  • Fax:
Mailing address:
  • Phone: 732-516-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00282800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: