Provider Demographics
NPI:1508843186
Name:GHONIEM, AYMAN A (MD)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:A
Last Name:GHONIEM
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 1:34 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:812-320-7229
Mailing Address - Fax:
Practice Address - Street 1:34 WINDING WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:812-320-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0428222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39069Medicare UPIN