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General NPI Number Information
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NPI Number | 1447440300
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Entity Type | Individual
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Provider Name | NICKHIL GUPTA D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 250 STELTON RD STE 3
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3285
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Country | US
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Telephone | 732-752-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E 20TH ST APT #2D
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City | NEW YORK
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State | NY
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Zip | 10009-8311
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Country | US
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Telephone | 732-259-2813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MB0902260
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 263627
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MB09022600
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 263627
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License Number State | NY
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