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1477559763

NPI Code Detail

MEDICARE: DIVYA GUPTA MD

MEDICARE: DIVYA 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	2084N0400X	Neurology Physician	25MA08156200	NJ
2	2084N0600X	Clinical Neurophysiology Physician	25MA08156200	NJ
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	25MA08156200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130000567	OTHER		UCHC, FARMINGTON, CT
2	130000575	OTHER		ECHN, MANCHESTER, CT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477559763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYA GUPTA MD

Provider Business Mailing Address
First Line	:	65 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3947
Country	:	US
Telephone Number	:	732-321-7010
Fax Number	:	732-744-5873

Provider Business Practice Location Address
First Line	:	65 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3947
Country	:	US
Telephone Number	:	732-321-7010
Fax Number	:	732-744-5873

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/21/2022

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65 JAMES ST
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1609679810 — DR. TASFIQUL I CHOWDHURY MD
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1790273449 — MICHAEL S MEROLLA MD
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1942132410 — MS. MILEDYS GONZALEZ RN
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1336765783 — SHIRLEY SHEN MD
Practice Location Address:

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1346261849 — DR. CAROLINE MCCAGG M.D.
Practice Location Address:

65 JAMES ST
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08820-3947

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Directions to “ DIVYA GUPTA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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