1972954915 NPI number — DEEPTI P GANDHI PT, DPT

Table of content: DEEPTI P GANDHI PT, DPT (NPI 1972954915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972954915 NPI number — DEEPTI P GANDHI PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDHI
Provider First Name:
DEEPTI
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRASAD
Provider Other First Name:
DEEPTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972954915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3228 STATE ROUTE 27 STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENDALL PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08824-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-297-0032
Provider Business Mailing Address Fax Number:
732-297-0558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 LIBERTY ST STE 1032
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINSBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08536-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-785-5386
Provider Business Practice Location Address Fax Number:
609-785-5388
Provider Enumeration Date:
06/30/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT025244 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 40QA01730600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)