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General NPI Number Information
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NPI Number | 1669181780
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Entity Type | Organization
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Legal Business Name | MAHMOUD ABU-GHANAM PHYSICIAN, P.C.
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1987 STATE ROUTE 52 STE 10
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City | LIBERTY
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State | NY
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Zip | 12754-8317
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Country | US
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Telephone | 845-292-0078
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Fax | 845-292-3244
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | FERNDALE
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State | NY
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Zip | 12734-0190
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Country | US
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Telephone | 845-292-0078
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Fax | 845-292-3244
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Authorized Official
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Title or Position | OWNER
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Name | MAHMOUD ABU GHANAM
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Credential | MD
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Telephone | 845-707-3092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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