Provider Demographics
NPI:1154867620
Name:GHANI, ATAUL (PA)
Entity Type:Individual
Prefix:
First Name:ATAUL
Middle Name:
Last Name:GHANI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:ST. PETER'S HEALTH PARTNERS PAYER CREDENTIALING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:53 COLUMBIA STREET
Practice Address - Street 2:ST. PETER'S HOSPITAL RENSSELAER HEALTH CENTER
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2933
Practice Address - Country:US
Practice Address - Phone:518-434-2526
Practice Address - Fax:518-434-2595
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant