Provider Demographics
NPI:1700366531
Name:GANLEY, ANDREW T
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:GANLEY
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 1:338 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3954
Mailing Address - Country:US
Mailing Address - Phone:551-358-8478
Mailing Address - Fax:
Practice Address - Street 1:461 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-3003
Practice Address - Country:US
Practice Address - Phone:201-857-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
246ZE0600XOtherELECTRODIAGNOSTIC TECHNICIAN TAXONOMY