Provider Demographics
NPI:1699745828
Name:GUPTA, KAVITA (DO)
Entity type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3001
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0598
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:705 WHITE HORSE RD
Practice Address - Street 2:STE D101
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2468
Practice Address - Country:US
Practice Address - Phone:856-751-7799
Practice Address - Fax:856-751-6660
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07408300208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021466Medicaid
NJ075851C60Medicare ID - Type Unspecified
NJH98020Medicare UPIN