Provider Demographics
NPI:1669862462
Name:GANGULI, SUHAS (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:
Last Name:GANGULI
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 1:19 DAVIS AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:732-775-5500
Mailing Address - Fax:
Practice Address - Street 1:19 DAVIS AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-755-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68801207RR0500X, 208000000X
NJ25MA113798002080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics