Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD417029 | PA |
N | 208000000X | Pediatrician | MD417029 | PA |
NPI | 1740202159 |
---|---|
Provider Name | Jaya B Ganesh |
First Address | New York, NY 10029-6504 |
Second Address | New York, NY 10029-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015857 | (05) | NJ |
100841117 | (05) | PA |
8J8241 | EBCBS (01) | NY |
H97393 | (02) |