Provider Demographics
NPI:1124023353
Name:GANDHI, SANJAY PANKAJ (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:PANKAJ
Last Name:GANDHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GORDONS CORNER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3351
Mailing Address - Country:US
Mailing Address - Phone:732-446-7136
Mailing Address - Fax:732-446-7138
Practice Address - Street 1:215 GORDONS CORNER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3351
Practice Address - Country:US
Practice Address - Phone:732-446-7136
Practice Address - Fax:732-446-7138
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005953213ES0103X
NJ25MD00275700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0052779Medicaid
NJU97471Medicare UPIN
NJ0052779Medicaid