Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT210707 | PA |
N | 111NI0900X | Internist | MT210707 | PA |
Y | 207RR0500X | Rheumatology | MT210707 | PA |
NPI | 1053760835 |
---|---|
Provider Name | Dr. Jay Ghadiali |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2016 |
Last Update Date | 20/02/2020 |