Provider Demographics
NPI:1013526516
Name:GANDAPODI, SAIKUMAR (LAC)
Entity Type:Individual
Prefix:
First Name:SAIKUMAR
Middle Name:
Last Name:GANDAPODI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 NEW DOVER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1956
Mailing Address - Country:US
Mailing Address - Phone:732-503-9900
Mailing Address - Fax:
Practice Address - Street 1:2864 STATE ROUTE 27
Practice Address - Street 2:LINCOLN PROFESSIONAL CENTER, SUITE C
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1956
Practice Address - Country:US
Practice Address - Phone:732-503-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist