Provider Demographics
NPI:1447440300
Name:GUPTA, NICKHIL (DO)
Entity type:Individual
Prefix:DR
First Name:NICKHIL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 20TH ST
Mailing Address - Street 2:APT #2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8311
Mailing Address - Country:US
Mailing Address - Phone:732-259-2813
Mailing Address - Fax:
Practice Address - Street 1:250 STELTON RD STE 3
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3285
Practice Address - Country:US
Practice Address - Phone:732-752-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0902260208100000X
NY263627208100000X, 2081P2900X
NJ25MB090226002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ784955OtherGROUP MEDICARE NUMBER JERSEY REHAB PA 1629005012
NJ784955OtherGROUP MEDICARE NUMBER JERSEY REHAB PA 1629005012