Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 037254 | NY |
NPI | 1063417061 |
---|---|
Provider Name | Dr. Ron Ganik |
First Address | New York, NY 10016-1201 |
Second Address | New York, NY 10016-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 06/10/2011 |