Provider Demographics
NPI:1992769947
Name:GANTI, S RAMAIAH (MD)
Entity type:Individual
Prefix:
First Name:S
Middle Name:RAMAIAH
Last Name:GANTI
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 1:350 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-894-3400
Mailing Address - Fax:201-894-5244
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:ENGLEWOOD HOSPITAL & MEDICAL CENTER
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-3400
Practice Address - Fax:201-894-5244
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA267002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6814301Medicaid
C09545Medicare UPIN
NJ6814301Medicaid