Provider Demographics
NPI:1902546468
Name:GANDHI, HEENAL (PA)
Entity Type:Individual
Prefix:
First Name:HEENAL
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MANITO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-3006
Mailing Address - Country:US
Mailing Address - Phone:973-722-6248
Mailing Address - Fax:
Practice Address - Street 1:33 MANITO AVE
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-3006
Practice Address - Country:US
Practice Address - Phone:973-722-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant