Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 055152 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 055152 | CT |
NPI | 1003808767 |
---|---|
Provider Name | Dr. Edmund Anthony Ganal |
First Address | New Milford, CT 06776-3485 |
Second Address | New Milford, CT 06776-3485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 06/07/2016 |