Provider Demographics
NPI:1366538787
Name:GANDHI, SANDEEP A (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:A
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANDEEP
Other - Middle Name:A
Other - Last Name:GANDHI, MD,PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-0829
Mailing Address - Country:US
Mailing Address - Phone:888-695-0385
Mailing Address - Fax:516-338-7974
Practice Address - Street 1:1300 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2031
Practice Address - Country:US
Practice Address - Phone:888-695-0385
Practice Address - Fax:516-338-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1914841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01795188Medicaid
NYG61767Medicare UPIN
NY01795188Medicaid