Healthcare Provider Details

I. General information

NPI: 1285612119
Provider Name (Legal Business Name): EMAD ADLY GHALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

16 SABRINA LN
STATEN ISLAND NY
10304-2947
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-8479
  • Fax: 212-423-7846
Mailing address:
  • Phone: 212-423-8479
  • Fax: 212-423-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number219864
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number219864
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME81290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: