Provider Demographics
NPI:1932154762
Name:GUPTA INSTITUTE FOR PAIN, WELLNESS AND REHABILITATION, LLC
Entity type:Organization
Organization Name:GUPTA INSTITUTE FOR PAIN, WELLNESS AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-482-7246
Mailing Address - Street 1:100 SPRINGDALE RD STE B5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3366
Mailing Address - Country:US
Mailing Address - Phone:856-482-7246
Mailing Address - Fax:856-482-7245
Practice Address - Street 1:100 SPRINGDALE RD STE B5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3366
Practice Address - Country:US
Practice Address - Phone:856-482-7246
Practice Address - Fax:856-482-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA 077138002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88074Medicare UPIN