Healthcare Provider Details

I. General information

NPI: 1356661649
Provider Name (Legal Business Name): GHAZAL SINHA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SMITH HAVEN MALL # 202
LAKE GROVE NY
11755-1219
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5858
  • Fax: 631-444-1899
Mailing address:
  • Phone: 631-444-5858
  • Fax: 631-444-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number271608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: