Provider Demographics
NPI:1811951635
Name:GANDHI, JATIN D (MD)
Entity type:Individual
Prefix:
First Name:JATIN
Middle Name:D
Last Name:GANDHI
Suffix:
Gender:M
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:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:NJ
Mailing Address - Zip Code:08353-0109
Mailing Address - Country:US
Mailing Address - Phone:856-451-9395
Mailing Address - Fax:856-451-8615
Practice Address - Street 1:390 N BROADWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1253
Practice Address - Country:US
Practice Address - Phone:856-678-7474
Practice Address - Fax:856-678-3018
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03647300207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3079406Medicaid
NJ0072366000OtherAMERIHEALTH
D96393Medicare UPIN
NJ027560Medicare PIN