Provider Demographics
NPI:1972570240
Name:GANCHI, PARHAM AMIR (PHD, MD)
Entity Type:Individual
Prefix:
First Name:PARHAM
Middle Name:AMIR
Last Name:GANCHI
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:# 307
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2156
Mailing Address - Country:US
Mailing Address - Phone:973-942-6600
Mailing Address - Fax:
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:# 307
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2156
Practice Address - Country:US
Practice Address - Phone:973-942-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07408100208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9131302Medicaid
NJ059069Medicare ID - Type Unspecified
NJ9131302Medicaid