Healthcare Provider Details

I. General information

NPI: 1083536999
Provider Name (Legal Business Name): GANDHISPINEMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CRANE RD
MOUNTAIN LAKES NJ
07046-1604
US

IV. Provider business mailing address

34 CRANE RD
MOUNTAIN LAKES NJ
07046-1604
US

V. Phone/Fax

Practice location:
  • Phone: 862-571-9960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JIGAR GANDHI
Title or Position: PHYSICIAN
Credential: MD
Phone: 862-571-9960