Healthcare Provider Details

I. General information

NPI: 1710282363
Provider Name (Legal Business Name): DAVID GANDLER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 88TH ST SUITE GRB
NEW YORK NY
10128-0535
US

IV. Provider business mailing address

12 E 88TH ST SUITE GRB
NEW YORK NY
10128-0535
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-5888
  • Fax: 212-410-5888
Mailing address:
  • Phone: 212-410-5888
  • Fax: 212-410-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number147222
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID GANDLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-410-5888