Healthcare Provider Details

I. General information

NPI: 1811986458
Provider Name (Legal Business Name): ANUP R GHEEWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 OCEAN AVE SUITE#7
BROOKLYN NY
11235-3170
US

IV. Provider business mailing address

2818 OCEAN AVE SUITE#7
BROOKLYN NY
11235-3170
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-2330
  • Fax: 718-332-2923
Mailing address:
  • Phone: 718-616-2330
  • Fax: 718-332-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number1762401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: