Provider Demographics
NPI:1396777967
Name:GHALY, NADER N (MD)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:N
Last Name:GHALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHRIS GAUPP DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-748-7580
Mailing Address - Fax:609-748-7574
Practice Address - Street 1:415 CHRIS GAUPP DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-748-7580
Practice Address - Fax:609-748-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04856800174400000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5038502Medicaid
E65441Medicare UPIN
NJ549184Medicare PIN