Provider Demographics
NPI:1215196043
Name:GANDHI, ZINDADIL MANOJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ZINDADIL
Middle Name:MANOJ
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2002
Mailing Address - Country:US
Mailing Address - Phone:856-282-5560
Mailing Address - Fax:856-282-5583
Practice Address - Street 1:54 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-282-5560
Practice Address - Fax:856-282-5583
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4459582084P0800X
NJ25MA092273002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ31-4011Medicare PIN