Provider Demographics
NPI:1922666940
Name:GPDDC, LLC
Entity Type:Organization
Organization Name:GPDDC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GURJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMAR
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:212-979-3237
Mailing Address - Street 1:250 PARK AVE S FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1402
Mailing Address - Country:US
Mailing Address - Phone:212-979-3237
Mailing Address - Fax:212-979-3447
Practice Address - Street 1:2 BENNETT AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2148
Practice Address - Country:US
Practice Address - Phone:212-979-3237
Practice Address - Fax:212-979-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02981359Medicaid