Individual
JASON C GANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 RESEARCH WAY, EAST SETAUKET, NY 11733-3487
(631) 444-4666
Mailing address
24 RESEARCH WAY, EAST SETAUKET, NY 11733-3487
(631) 444-4666
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
60-233290
NY
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
60-233290
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221046
UNISON
OH
01
—
000000503657
ANTHEM
OH
05
—
2595615
—
OH
01
—
363543
WELLCARE MEDICAID
OH
01
—
743421
BUCKEYE MEDICAID
OH
01
—
7720723
AETNA
OH
01
—
P00372950
MEDICARE RAILROAD
OH
Enumeration date
07/25/2006
Last updated
06/23/2009
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