MEDICARE: ATLANTICARE

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	261QP2300X	Primary Care Clinic/Center	25MA09472900	NJ

General Provider Information

NPI Number	:	1467857870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTICARE

Provider Business Mailing Address
First Line	:	1201 NEW RD STE 120
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1152
Country	:	US
Telephone Number	:	609-927-7070
Fax Number	:	609-927-7105

Provider Business Practice Location Address
First Line	:	1201 NEW RD STE 120
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1152
Country	:	US
Telephone Number	:	609-927-7070
Fax Number	:	609-927-7105

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	NAMITA GUPTA
Credential	:	M.D.
Telephone Number	:	267-207-0237

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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Directions to “ATLANTICARE ” Practice Location

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