Provider Demographics
NPI:1841741493
Name:MODY, BELA GANDHI (APN)
Entity Type:Individual
Prefix:
First Name:BELA
Middle Name:GANDHI
Last Name:MODY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1367
Mailing Address - Country:US
Mailing Address - Phone:973-826-4920
Mailing Address - Fax:
Practice Address - Street 1:12201 HIGHWAY 92 STE D
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7141
Practice Address - Country:US
Practice Address - Phone:470-956-3230
Practice Address - Fax:678-494-4013
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00678300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily