Healthcare Provider Details

I. General information

NPI: 1992191993
Provider Name (Legal Business Name): JENIL GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 PASSAIC AVE
LIVINGSTON NJ
07039-5811
US

IV. Provider business mailing address

PO BOX 7410723
CHICAGO IL
60674-0723
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-1122
  • Fax: 215-949-2384
Mailing address:
  • Phone: 609-585-1122
  • Fax: 215-949-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10536700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: