Provider Demographics
NPI:1306868138
Name:GANLY, IAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:GANLY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 YORK AVE
Mailing Address - Street 2:RM SR331
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6306
Mailing Address - Country:US
Mailing Address - Phone:212-639-6231
Mailing Address - Fax:212-396-5560
Practice Address - Street 1:1233 YORK AVE
Practice Address - Street 2:RM SR331
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6306
Practice Address - Country:US
Practice Address - Phone:212-639-6231
Practice Address - Fax:212-396-5560
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242698-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology