Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F308409-1 | NY |
NPI | 1023524816 |
---|---|
Provider Name | Mr. Ganesh Ram |
First Address | South Richmond Hill, NY 11419-3017 |
Second Address | Brooklyn, NY 11237-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2017 |
Last Update Date | 16/12/2017 |