Provider Demographics
NPI:1417164799
Name:GHOSHAL, PIYA (MD)
Entity Type:Individual
Prefix:
First Name:PIYA
Middle Name:
Last Name:GHOSHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BROADWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2797
Mailing Address - Country:US
Mailing Address - Phone:631-264-8600
Mailing Address - Fax:631-264-8403
Practice Address - Street 1:116 BROADWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2797
Practice Address - Country:US
Practice Address - Phone:631-264-8600
Practice Address - Fax:631-264-8403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine