Provider Demographics
NPI:1487771325
Name:GANDHI, THIMMA S (MD)
Entity type:Individual
Prefix:
First Name:THIMMA
Middle Name:S
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 KENNEDY BLVD E APT 48D
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4863
Mailing Address - Country:US
Mailing Address - Phone:201-861-2918
Mailing Address - Fax:201-861-2859
Practice Address - Street 1:30 W CENTURY RD
Practice Address - Street 2:SUITE 255
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1433
Practice Address - Country:US
Practice Address - Phone:201-444-4363
Practice Address - Fax:201-444-6590
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03963200207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19700Medicare UPIN
NJGA443412Medicare ID - Type Unspecified