Individual provider Active NPI

Bhavna Gangwal

  • Dentist
  • Hoboken, NJ
National Provider Identifier
1093497877
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI02984900 Issued in NJ
Practice address
1006 Washington St
Hoboken, NJ 07030-5210
Phone
(201) 792-7073
NPI assigned
Aug 2, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI02984900 NJ Primary

Addresses

Primary practice location

1006 Washington St
Hoboken, NJ 07030-5210

Mailing address

475 Washington Blvd Apt 4608N
Jersey City, NJ 07310-2152

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
22DI02984900NJMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1093497877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 WASHINGTON BLVD APT 4608N",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 WASHINGTON ST",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070305210",
            "telephone_number": "201-792-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGWAL",
        "first_name": "BHAVNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02984900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.