=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225038755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVANG A. GANDHI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2005
-----------------------------------------------------
Last Update Date | 04/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 MOUNT PLEASANT AVE
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-731-9442
-----------------------------------------------------
Fax | 973-731-2918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 375 MOUNT PLEASANT AVE
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-731-9442
-----------------------------------------------------
Fax | 973-731-2918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 25MA06006200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number | 25MA06006200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------