Individual ProviderManju GuptaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address332 Lafayette Avenue, Hawthorne, NJ 07506(973) 423-0145PECOS EnrollmentBased on the most recent information from CMS, provider Manju Gupta is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1790717528Provider TypeIndividualFull NameGupta, ManjuTitleDr.CredentialMDGenderFemaleSole ProprietorYesEnumeration Date7/6/2006Last Updated8/9/2012Contact InformationPractice LocationPractice Address332 Lafayette Avenue, Hawthorne, NJ 07506Phone(973) 423-0145Fax(973) 423-0667Mailing LocationMailing Address332 Lafayette Avenue, Hawthorne, NJ 07506Phone(973) 423-0145Fax(973) 423-0667Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseMA42995New JerseyProvider IdentifiersIDDescriptionIssuerID0898503DescriptionMedicaidIssuerUnlistedNew Jersey