Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22DI02575602 | NJ |
NPI | 1003293416 |
---|---|
Provider Name | Dr. Cassandra Gandia |
First Address | Fort Lee, NJ 07024-4151 |
Second Address | Ridgefield Park, NJ 07660-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 04/01/2019 |