Provider Demographics
NPI:1083157309
Name:GADANGI INCORPORATED
Entity Type:Organization
Organization Name:GADANGI INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:
Authorized Official - Last Name:GADANGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-400-3111
Mailing Address - Street 1:23 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5609
Mailing Address - Country:US
Mailing Address - Phone:917-400-3111
Mailing Address - Fax:718-332-2923
Practice Address - Street 1:2583 OCEAN AVE STE 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4575
Practice Address - Country:US
Practice Address - Phone:718-332-6207
Practice Address - Fax:718-332-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217129208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67L481Medicare UPIN