Provider Demographics
NPI:1659678100
Name:GHALI, MICHAEL S
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GHALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3551
Mailing Address - Country:US
Mailing Address - Phone:732-839-3300
Mailing Address - Fax:908-668-7894
Practice Address - Street 1:180 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3551
Practice Address - Country:US
Practice Address - Phone:732-839-3300
Practice Address - Fax:908-668-7894
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00018039247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
043079Medicare PIN