Healthcare Provider Details

I. General information

NPI: 1306065529
Provider Name (Legal Business Name): MAHENDRA GANJHU, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 23RD ST
WATERVLIET NY
12189-2126
US

IV. Provider business mailing address

PO BOX 14524
ALBANY NY
12212-4524
US

V. Phone/Fax

Practice location:
  • Phone: 518-274-2289
  • Fax: 518-274-2171
Mailing address:
  • Phone: 518-459-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHENDRA GANJHU
Title or Position: OWNER
Credential: MD
Phone: 518-274-2289