Provider Demographics
NPI:1356553168
Name:GHANTA, HIMABALA
Entity type:Individual
Prefix:DR
First Name:HIMABALA
Middle Name:
Last Name:GHANTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 UNIVERSITY PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6208
Mailing Address - Country:US
Mailing Address - Phone:201-833-3599
Mailing Address - Fax:201-227-6207
Practice Address - Street 1:200 ENGLE ST STE 14
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2417
Practice Address - Country:US
Practice Address - Phone:201-567-7615
Practice Address - Fax:201-567-8033
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10009900208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery