Provider Demographics
NPI:1396590493
Name:GUPTA KAUSHAL, ISHITA
Entity type:Individual
Prefix:
First Name:ISHITA
Middle Name:
Last Name:GUPTA KAUSHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAINT CLARE'S HEALTH GME OFFICE
Mailing Address - Street 2:25 POCONO ROAD
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-365-4661
Mailing Address - Fax:
Practice Address - Street 1:SAINT CLARE'S HEALTH GME OFFICE
Practice Address - Street 2:25 POCONO ROAD
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-365-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-12-20
Deactivation Date:2024-12-19
Deactivation Code:
Reactivation Date:2024-12-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program