Provider Demographics
NPI:1043306921
Name:GANDHI, JYOTI R
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:R
Last Name:GANDHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 25 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3359
Mailing Address - Country:US
Mailing Address - Phone:718-457-0500
Mailing Address - Fax:718-457-0501
Practice Address - Street 1:84 25 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3359
Practice Address - Country:US
Practice Address - Phone:718-457-0500
Practice Address - Fax:718-457-0501
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00198210Medicaid
NY81744Medicare ID - Type Unspecified
C67051Medicare UPIN