Provider Demographics
NPI:1063479939
Name:GHALY, NASRI N (MD)
Entity Type:Individual
Prefix:
First Name:NASRI
Middle Name:N
Last Name:GHALY
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:614 SOUTH SALINA STREET
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3520
Mailing Address - Country:US
Mailing Address - Phone:315-425-0599
Mailing Address - Fax:315-471-6760
Practice Address - Street 1:614 S SALINA ST
Practice Address - Street 2:SUITE #300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3500
Practice Address - Country:US
Practice Address - Phone:315-425-0599
Practice Address - Fax:315-471-6760
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY000402171100000X
NY1574652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825627Medicaid
NY39402BMedicare PIN