Healthcare Provider Details

I. General information

NPI: 1811951635
Provider Name (Legal Business Name): JATIN D GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N BROADWAY SUITE 500
PENNSVILLE NJ
08070-1253
US

IV. Provider business mailing address

PO BOX 109
SHILOH NJ
08353-0109
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-7474
  • Fax: 856-678-3018
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA03647300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: