Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gautam Gupta

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1356728869

Gautam Gupta is an Internal Medicine in Passaic, New Jersey. Qualified in 2014, 12 years ago. Practices with Elite Physicians LLC, a 2-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
12
Licensed in
NJ
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

350 Blvd
Passaic, NJ 07055-2840
Phone: (973) 365-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 17716 Phelps Hill Ln, Derwood, MD 20855 — (301) 740-3192
  • 1122 53rd St Apt 507, North Bergen, NJ 07047-3158 — (240) 408-6889
  • 1715 Us Highway 46 Apt 463, Parsippany, NJ 07054-2976 — (240) 408-6889

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 25MA10368900 (NJ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1356728869
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 5, 2015
Last updated in NPPESMarch 26, 2021
Certification dateMarch 12, 2021
Mailing address1122 53rd St Apt 507, North Bergen, NJ 07047-3158

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Elite Physicians Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Passaic