Provider Demographics
NPI:1932184728
Name:GUPTA, ANIL KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 HOOPER AVE
Mailing Address - Street 2:BUILDING B SUITE 2B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:856-263-6045
Mailing Address - Fax:
Practice Address - Street 1:1314 HOOPER AVE
Practice Address - Street 2:BUILDING B SUITE 2B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2586
Practice Address - Country:US
Practice Address - Phone:856-263-6045
Practice Address - Fax:856-263-6037
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06675900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8041806Medicaid
F97985Medicare UPIN
NJ030225S5BMedicare ID - Type Unspecified