Basic Information
| Provider Information | |||||||||
| NPI: | 1861446957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANESHKUMAR | ||||||||
| FirstName: | CHANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169380100 | ||||||||
| FaxNumber: | 5169380120 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169380100 | ||||||||
| FaxNumber: | 5169380120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 145133 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.