Provider Demographics
NPI:1982946174
Name:GANESH, HARIRAM (MD)
Entity Type:Individual
Prefix:
First Name:HARIRAM
Middle Name:
Last Name:GANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARI
Other - Middle Name:
Other - Last Name:GANESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1418
Mailing Address - Country:US
Mailing Address - Phone:516-467-4367
Mailing Address - Fax:
Practice Address - Street 1:2 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1418
Practice Address - Country:US
Practice Address - Phone:516-467-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09244800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics