Provider Demographics
NPI:1821057266
Name:GANEA, CAMELIA E (MD)
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:E
Last Name:GANEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3777 INDEPENDENCE AVE
Mailing Address - Street 2:APT 15F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1409
Mailing Address - Country:US
Mailing Address - Phone:718-707-3434
Mailing Address - Fax:718-707-3435
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:718-707-3434
Practice Address - Fax:718-707-3435
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177397Medicaid