Healthcare Provider Details

I. General information

NPI: 1902824782
Provider Name (Legal Business Name): EMIL GANJIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MINEOLA BLVD
MINEOLA NY
11501
US

IV. Provider business mailing address

134 MINEOLA BLVD
MINEOLA NY
11501
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-9363
  • Fax: 516-294-6228
Mailing address:
  • Phone: 516-294-9363
  • Fax: 516-294-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number2024091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: