MEDICARE: DR. AKSHAY GANJU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	288709-1	NY

General Provider Information

NPI Number	:	1083032056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKSHAY GANJU M.D.

Provider Business Mailing Address
First Line	:	45 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6257
Country	:	US
Telephone Number	:	212-772-9222
Fax Number	:	212-879-7235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	07/10/2023

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