Organization
GRAND STREET MEDICAL PLLC
Active
Other names
Jayant H. Gandhi,M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEMA J GANDHI (ADMINISTRATION)
(718) 782-4768
Entity
Organization
Contact information
Practice address
666 GRAND ST, BROOKLYN, NY 11211-4853
(718) 963-0555
(718) 963-4889
Mailing address
80 E END AVE, 14-B, NEW YORK, NY 10028-8004
(212) 734-9031
(212) 794-2441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
111281
NY
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
111281
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
111281
NY
207RX0202X
Medical Oncology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
111281
NY
208600000X
Surgery Physician
111281
NY
208D00000X
General Practice Physician
Primary
111281
NY
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00199748
—
NY
01
—
0192659
GRAND STREET MEDICAL PC
NY
05
—
03196274
—
NY
01
—
11128160NY
1199 NATIONAL BENEFIT
NY
01
—
12295130
CAQH
—
01
—
55247
HIP
NY
01
—
GJ617239
GHI
NY
05
—
WPPD41
—
NY
Enumeration date
07/26/2006
Last updated
04/18/2012
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