Healthcare Provider Details

I. General information

NPI: 1013847045
Provider Name (Legal Business Name): GHADA EL BANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 188TH ST
FRESH MEADOWS NY
11365-3767
US

IV. Provider business mailing address

4828 210TH ST
OAKLAND GARDENS NY
11364-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-6460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: