Provider Demographics
NPI:1659459949
Name:SASTRY, GAYATHRI (MD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:SASTRY
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 1:257 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4478
Mailing Address - Country:US
Mailing Address - Phone:201-445-2200
Mailing Address - Fax:201-445-2204
Practice Address - Street 1:257 E RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4478
Practice Address - Country:US
Practice Address - Phone:201-445-2200
Practice Address - Fax:201-445-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056461002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94840Medicare UPIN
NJ677378Medicare PIN