Provider Demographics
NPI:1346241858
Name:GANZ, ERIC MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:GANZ
Suffix:
Gender:M
Credentials:MD
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 95000-2243
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-338-1075
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-4000
Practice Address - Fax:212-523-8066
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2030701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01745275Medicaid
NYG45239Medicare UPIN
NY36G143Medicare ID - Type Unspecified