Provider Demographics
NPI:1649089038
Name:GANDRE, ARCHANA (LAC)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:GANDRE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HUDSON ST APT 1611E
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-7547
Mailing Address - Country:US
Mailing Address - Phone:917-815-0331
Mailing Address - Fax:
Practice Address - Street 1:33 HUDSON ST APT 1611E
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-7547
Practice Address - Country:US
Practice Address - Phone:917-815-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist