Provider Demographics
NPI:1013234368
Name:GHANAAT, MAHYAR (MD)
Entity Type:Individual
Prefix:
First Name:MAHYAR
Middle Name:
Last Name:GHANAAT
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 1:8 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 BEACH RD
Practice Address - Street 2:APT 1S
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1143
Practice Address - Country:US
Practice Address - Phone:631-444-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAETL49452085N0700X, 2085R0202X
NY2791052085N0700X, 2085R0202X
PAMD4593282085N0700X, 2085R0202X
NJ25MA107825002085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology