Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 142117 | CA |
N | 208600000X | Surgeon | 142117 | CA |
N | 208200000X | Surgeon | 25MA10153500 | NJ |
N | 208600000X | Surgeon | 25MA10153500 | NJ |
Y | 208200000X | Surgeon | 292312-1 | NY |
Y | 208600000X | Surgeon | 292312-1 | NY |
NPI | 1003131053 |
---|---|
Provider Name | Dr. Brad Michael Gandolfi |
First Address | Hoboken, NJ 07030-1603 |
Second Address | New York, NY 10021-4156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 11/11/2021 |