Provider Demographics
NPI:1972565562
Name:BHAMBHANI, GHANSHYAM (MD)
Entity type:Individual
Prefix:
First Name:GHANSHYAM
Middle Name:
Last Name:BHAMBHANI
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 1:10706 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1813
Mailing Address - Country:US
Mailing Address - Phone:718-323-2229
Mailing Address - Fax:718-323-6811
Practice Address - Street 1:10706 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1813
Practice Address - Country:US
Practice Address - Phone:718-323-2229
Practice Address - Fax:718-323-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204823207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001K91Medicare ID - Type Unspecified
NY04581GMedicare PIN
NYG26951Medicare UPIN