Provider Demographics
NPI:1053434852
Name:GHANI, WASIM UL (MD)
Entity type:Individual
Prefix:DR
First Name:WASIM
Middle Name:UL
Last Name:GHANI
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 1:2532 21ST ST
Mailing Address - Street 2:IST FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3546
Mailing Address - Country:US
Mailing Address - Phone:347-683-1072
Mailing Address - Fax:
Practice Address - Street 1:127 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7000
Practice Address - Fax:914-378-1711
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
NY245017207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02937768Medicaid
NY777490356OtherBCBS
NY777490356OtherBCBS
NYJ400003822Medicare UPIN