Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA03681500 | NJ |
N | 208600000X | Surgeon | 25MA03681500 | NJ |
N | 2086S0120X | Pediatric Surgery | 25MA03681500 | NJ |
NPI | 1467527424 |
---|---|
Provider Name | Amir Ganchi |
First Address | Wayne, NJ 07470 |
Second Address | Wayne, NJ 07470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2624708 | (05) | NJ |
D06210 | (02) |