Provider Demographics
NPI:1235176355
Name:GANDHI, JAYANT H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANT
Middle Name:H
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYANT
Other - Middle Name:H
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:80 E END AVE
Mailing Address - Street 2:SUITE -14B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-8004
Mailing Address - Country:US
Mailing Address - Phone:212-734-9031
Mailing Address - Fax:718-782-3677
Practice Address - Street 1:80 E END AVE
Practice Address - Street 2:SUITE -14B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-8004
Practice Address - Country:US
Practice Address - Phone:212-734-9031
Practice Address - Fax:718-782-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111281207QA0401X, 207QG0300X, 208600000X, 208D00000X, 207QA0505X
NY111281-2208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00199748Medicaid
NY1235176355OtherNPI
B78173Medicare UPIN
NY58276PPD41Medicare PIN
NY58276PPD41Medicare PIN