Provider Demographics
NPI:1427153519
Name:GHANDER, ATIF Z (MD)
Entity type:Individual
Prefix:DR
First Name:ATIF
Middle Name:Z
Last Name:GHANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:N CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4527
Mailing Address - Country:US
Mailing Address - Phone:973-364-0538
Mailing Address - Fax:
Practice Address - Street 1:13 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:N CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4527
Practice Address - Country:US
Practice Address - Phone:973-364-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02466300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000084302OtherAMERICHOICE
NJ1235300799Other37 NO DAY ST
NJ1658506Medicaid
NJ1932370483Other101 LUDLOW
NJ1740345693Other741 BROADWAY
NJ1194996645Other444 WILLIAM ST
NJ01000084302OtherAMERICHOICE
NJ1932370483Other101 LUDLOW
NJC63205Medicare UPIN