Healthcare Provider Details

I. General information

NPI: 1245200963
Provider Name (Legal Business Name): ANJALI R. GUPTA, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 NORTHFIELD AVE SUITE 114
WEST ORANGE NJ
07052-1198
US

IV. Provider business mailing address

769 NORTHFIELD AVE SUITE 114
WEST ORANGE NJ
07052-1198
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-9100
  • Fax: 973-736-9330
Mailing address:
  • Phone: 973-736-9100
  • Fax: 973-736-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMA07665900
License Number StateNJ

VIII. Authorized Official

Name: DR. ANJALI GUPTA
Title or Position: PHYSICIAN
Credential: M.D
Phone: 973-736-9100