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General NPI Number Information
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NPI Number | 1407805914
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Entity Type | Individual
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Provider Name | PANCHALI GANGULY M.D
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 150 AIRPORT RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-6924
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Country | US
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Telephone | 609-233-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MEADOW DR
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City | PLAINSBORO
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State | NJ
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Zip | 08536-1958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07547300
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License Number State | NJ
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