Healthcare Provider Details

I. General information

NPI: 1972741056
Provider Name (Legal Business Name): NADER GANIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 E MAIN STREET RD STE 2
BATAVIA NY
14020-3444
US

IV. Provider business mailing address

598 10TH AVE APT 4R
NEW YORK NY
10036-3002
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-1421
  • Fax:
Mailing address:
  • Phone: 212-444-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number131074191
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME125309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: