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General NPI Number Information
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NPI Number | 1487796819
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Entity Type | Organization
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Legal Business Name | ROBERT I GANELES MD PC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 60 CUTTERMILL ROAD SUITE 507
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-482-0404
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Fax | 203-292-5129
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Provider Business Mailing Address
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Address Line | 60 CUTTERMILL ROAD SUITE 507
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-482-0404
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Fax | 203-292-5129
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT I GANELES
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Credential | MD
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Telephone | 516-482-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 083752
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License Number State | NY
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