Provider Demographics
NPI:1598397622
Name:GANDHI, DISHA D
Entity Type:Individual
Prefix:
First Name:DISHA
Middle Name:D
Last Name:GANDHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17269 HIGHLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2878
Mailing Address - Country:US
Mailing Address - Phone:714-705-5309
Mailing Address - Fax:
Practice Address - Street 1:675 3RD AVE
Practice Address - Street 2:APT3
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10017-1143
Practice Address - Country:US
Practice Address - Phone:714-705-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist