Provider Demographics
NPI:1407920606
Name:GANTI, SUBRAHMANYAM (MD,)
Entity Type:Individual
Prefix:DR
First Name:SUBRAHMANYAM
Middle Name:
Last Name:GANTI
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 1:10 ANGELA CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5753
Mailing Address - Country:US
Mailing Address - Phone:732-463-2245
Mailing Address - Fax:732-463-2125
Practice Address - Street 1:906 OAK TREE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:908-822-1181
Practice Address - Fax:908-822-1480
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics