Provider Demographics
NPI:1467528117
Name:GAVANI, SOBHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SOBHA
Middle Name:D
Last Name:GAVANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1068
Mailing Address - Country:US
Mailing Address - Phone:914-771-8373
Mailing Address - Fax:
Practice Address - Street 1:1234 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1068
Practice Address - Country:US
Practice Address - Phone:914-771-8373
Practice Address - Fax:914-771-8375
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179341207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052564Medicaid
NY02052564Medicaid
NYG10303Medicare UPIN