Healthcare Provider Details

I. General information

NPI: 1083157309
Provider Name (Legal Business Name): GADANGI INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 OCEAN AVE STE 1R
BROOKLYN NY
11229-4575
US

IV. Provider business mailing address

23 FOSTER AVE
STATEN ISLAND NY
10314-5609
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-6207
  • Fax: 718-332-2923
Mailing address:
  • Phone: 917-400-3111
  • Fax: 718-332-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number217129
License Number StateNY

VIII. Authorized Official

Name: DR. PRATAP GADANGI
Title or Position: PHYSICIAN
Credential: MD
Phone: 917-400-3111