Provider Demographics
NPI:1669452553
Name:GANDHI, NABILA A (MD)
Entity Type:Individual
Prefix:
First Name:NABILA
Middle Name:A
Last Name:GANDHI
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 1:35-37 PROGRESS ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1179
Mailing Address - Country:US
Mailing Address - Phone:908-755-9797
Mailing Address - Fax:908-668-4845
Practice Address - Street 1:35-37 PROGRESS ST
Practice Address - Street 2:SUITE A3
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1179
Practice Address - Country:US
Practice Address - Phone:908-755-9797
Practice Address - Fax:908-668-4845
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051546Medicare ID - Type Unspecified