Provider Demographics
NPI:1619918463
Name:GANCHI, PEDRAMINE
Entity Type:Individual
Prefix:
First Name:PEDRAMINE
Middle Name:
Last Name:GANCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEDY
Other - Middle Name:
Other - Last Name:GANCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:486 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:246 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1635
Practice Address - Country:US
Practice Address - Phone:201-995-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69709208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH05913Medicare UPIN
NJ032009Medicare ID - Type Unspecified