Provider Demographics
NPI:1740200823
Name:SINGH, GHANSHAM (MD)
Entity type:Individual
Prefix:DR
First Name:GHANSHAM
Middle Name:
Last Name:SINGH
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 1:61 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2413
Mailing Address - Country:US
Mailing Address - Phone:516-791-3129
Mailing Address - Fax:718-250-8120
Practice Address - Street 1:11714 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1927
Practice Address - Country:US
Practice Address - Phone:718-848-0411
Practice Address - Fax:718-848-0811
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020991Medicaid
NY02020991Medicaid
NYG95394Medicare UPIN