Provider Demographics
NPI:1528134889
Name:GANDHI, LAJPAT RAI (MD)
Entity type:Individual
Prefix:DR
First Name:LAJPAT
Middle Name:RAI
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 1:2 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-496-3142
Mailing Address - Fax:516-496-3142
Practice Address - Street 1:110 EAST MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-427-6411
Practice Address - Fax:631-427-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1409192084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00609063Medicaid
51A951Medicare ID - Type Unspecified
NY00609063Medicaid