Healthcare Provider Details

I. General information

NPI: 1982621512
Provider Name (Legal Business Name): PRATAP KUMAR GADANGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 OCEAN AVE 7
BROOKLYN NY
11235-3170
US

IV. Provider business mailing address

23 FOSTER AVENUE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-6207
  • Fax: 718-332-2923
Mailing address:
  • Phone: 718-698-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number217129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: