Healthcare Provider Details

I. General information

NPI: 1235176355
Provider Name (Legal Business Name): JAYANT H GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAYANT H. GANDHI M.D.

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E END AVE SUITE -14B
NEW YORK NY
10028-8004
US

IV. Provider business mailing address

80 E END AVE SUITE -14B
NEW YORK NY
10028-8004
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-9031
  • Fax: 718-782-3677
Mailing address:
  • Phone: 212-734-9031
  • Fax: 718-782-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number111281
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number111281
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111281
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number111281
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number111281
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number111281-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: