Basic Information
| Provider Information | |||||||||
| NPI: | 1053434852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHANI | ||||||||
| FirstName: | WASIM | ||||||||
| MiddleName: | UL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2532 21ST ST | ||||||||
| Address2: | IST FLOOR | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111023546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476831072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 127 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107014006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143787000 | ||||||||
| FaxNumber: | 9143781711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2007 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 207P00000X | 245017 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02937768 | 05 | NY | MEDICAID | 777490356 | 01 | NY | BCBS | OTHER |