Healthcare Provider Details

I. General information

NPI: 1477734986
Provider Name (Legal Business Name): NISHANT ASHOK GANDHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 MEMORIAL BLVD STE A
CONNELLSVILLE PA
15425-1405
US

IV. Provider business mailing address

PO BOX 1202
NEWARK NJ
07101-1202
US

V. Phone/Fax

Practice location:
  • Phone: 724-603-3560
  • Fax: 724-603-3561
Mailing address:
  • Phone: 212-427-2666
  • Fax: 212-289-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number263559
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS019510
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS019510
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: