Provider Demographics
NPI:1235226689
Name:GANJIAN, AFSHIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:GANJIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3025
Mailing Address - Country:US
Mailing Address - Phone:718-235-6100
Mailing Address - Fax:718-827-6521
Practice Address - Street 1:146 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3025
Practice Address - Country:US
Practice Address - Phone:718-235-6100
Practice Address - Fax:718-827-6521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01767913Medicaid
NY01767913Medicaid
NYP70111Medicare ID - Type Unspecified