Basic Information
| Provider Information | |||||||||
| NPI: | 1467779637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | JITESH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 EAGLE AVE | ||||||||
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| City: | OCEAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077127631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326606200 | ||||||||
| FaxNumber: | 7324939981 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 5TH AVE RM 410 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100165007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127253778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 08/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 032232 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.