MEDICARE: DR. GAURAV GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	25MA08236700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285898312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAURAV GUPTA MD

Provider Business Mailing Address
First Line	:	125 PATERSON ST
Second Line	:	CAB 2102
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1962
Country	:	US
Telephone Number	:	732-235-7756
Fax Number	:	732-235-7095

Provider Business Practice Location Address
First Line	:	125 PATERSON ST
Second Line	:	CAB 2102
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1962
Country	:	US
Telephone Number	:	732-235-7756
Fax Number	:	732-235-7095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	03/16/2017

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