Provider Demographics
NPI:1629180344
Name:GANDHI, KIRIT V (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRIT
Middle Name:V
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KIRIT
Other - Middle Name:
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3665 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3210
Mailing Address - Country:US
Mailing Address - Phone:201-963-1155
Mailing Address - Fax:201-963-7957
Practice Address - Street 1:3665 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3210
Practice Address - Country:US
Practice Address - Phone:201-963-1155
Practice Address - Fax:201-963-7957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO454934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ188350001Medicaid
NJ454934Medicare ID - Type Unspecified
NJ188350001Medicaid