Provider Demographics
NPI:1427097039
Name:GUPTA, SHABNAM (MD)
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-994-4550
Mailing Address - Fax:973-994-7085
Practice Address - Street 1:22 OLD SHORT HILLS RD STE 212
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5605
Practice Address - Country:US
Practice Address - Phone:973-994-4550
Practice Address - Fax:973-994-7085
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07461900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
066843AYWMedicare ID - Type Unspecified
H43480Medicare UPIN