Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 60-233290 | NY |
Y | 208600000X | Surgeon | 60-233290 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 60-233290 | NY |
NPI | 1215950910 |
---|---|
Provider Name | Jason C Ganz |
First Address | East Setauket, NY 11733-3487 |
Second Address | East Setauket, NY 11733-3487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 23/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000221046 | UNISON (01) | OH |
000000503657 | ANTHEM (01) | OH |
2595615 | (05) | OH |
363543 | WELLCARE MEDICAID (01) | OH |
743421 | BUCKEYE MEDICAID (01) | OH |
7720723 | AETNA (01) | OH |
I25723 | (02) | |
P00372950 | MEDICARE RAILROAD (01) | OH |