Provider Demographics
NPI:1285612119
Name:GHALY, EMAD ADLY (MD)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:ADLY
Last Name:GHALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:16 SABRINA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2947
Mailing Address - Country:US
Mailing Address - Phone:212-423-8479
Mailing Address - Fax:212-423-7846
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-8479
Practice Address - Fax:212-423-7846
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219864208000000X, 2080N0001X
FLME812902080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY105073Medicare UPIN