Basic Information
| Provider Information | |||||||||
| NPI: | 1306097332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | SUNNY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2673393761 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 ROUTE 73 N STE 401 | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2674791321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OT011023 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | OS013699 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | OS013699 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 25MB09249700 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 311153 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.