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General NPI Number Information
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NPI Number | 1710277421
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Entity Type | Organization
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Legal Business Name | ROLAND A GHANEM,MD LLC
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 362 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2554
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Country | US
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Telephone | 973-790-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 362 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2554
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Country | US
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Telephone | 973-790-6707
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROLAND A GHANEM
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Credential | MD
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Telephone | 973-790-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA02477700
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License Number State | NJ
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