Provider Demographics
NPI:1396717112
Name:GHALY, ANTOINE (MD)
Entity type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:
Last Name:GHALY
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 1:3037 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1224
Mailing Address - Country:US
Mailing Address - Phone:716-283-1666
Mailing Address - Fax:716-283-1624
Practice Address - Street 1:3037 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1224
Practice Address - Country:US
Practice Address - Phone:716-283-1666
Practice Address - Fax:716-283-1624
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG64430Medicare UPIN
NYBB9760Medicare ID - Type Unspecified