Provider Demographics
NPI:1700829496
Name:HAMSA, GANGASWAMAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:GANGASWAMAIAH
Middle Name:
Last Name:HAMSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GANGASWAMAIAH
Other - Middle Name:
Other - Last Name:HAMSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15 OLSEN CT
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:201-920-2304
Mailing Address - Fax:
Practice Address - Street 1:1555 RUTH RD STE 6
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4074
Practice Address - Country:US
Practice Address - Phone:732-821-9200
Practice Address - Fax:732-821-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07698400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ91001472100OtherAMERICHOICE OF NEW JERSEY
NJP00158189OtherRAILROAD MEDICARE
NJ0047392Medicaid
NJ7686632OtherAETNA
NJ0047392Medicaid
NJ91001472100OtherAMERICHOICE OF NEW JERSEY