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NPI Code Detail

MEDICARE: DR. JAN GANESH PSY. D.

MEDICARE: DR. JAN GANESH PSY. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistPY7079FL

General Provider Information

NPI Number : 1871816132
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAN GANESH PSY. D.
Provider Business Mailing Address
First Line : 211 E BOYNTON BEACH BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-3839
Country : US
Telephone Number : 561-732-3236
Fax Number : 561-732-6849
Provider Business Practice Location Address
First Line : 211 E BOYNTON BEACH BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-3839
Country : US
Telephone Number : 561-732-3236
Fax Number : 561-732-6849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2010
Last Update Date : 08/09/2011

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Directions to “ DR. JAN GANESH PSY. D.” Practice Location

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