Provider Demographics
NPI:1043473382
Name:GANGULY, JOYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYA
Middle Name:A
Last Name:GANGULY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-993-7777
Mailing Address - Fax:313-993-2563
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 510
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-993-7777
Practice Address - Fax:313-993-2563
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY261243207RC0001X
MI4301087808207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03358321Medicaid
NYJ400049083Medicare PIN