Healthcare Provider Details

I. General information

NPI: 1144904392
Provider Name (Legal Business Name): FENIL GANDHI MD/MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BATH RD
BRISTOL PA
19007-3190
US

IV. Provider business mailing address

15105 CROSS ISLAND PKWY APT 4G
WHITESTONE NY
11357-2603
US

V. Phone/Fax

Practice location:
  • Phone: 929-464-6232
  • Fax:
Mailing address:
  • Phone: 347-234-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD493751
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT227899
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA12814800
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC1-0029162
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: