Active NPI
Bryan Abdul Ghanny, MD
- Pediatrics Physician
- Newark, NJ
National Provider Identifier
1639442619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA09804900
- Practice address
- 200 Washington St
Newark, NJ 07102-2921 - Phone
- (973) 622-3890
- NPI assigned
- Feb 21, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 25MA09804900 | NJ | Primary |
Addresses
Primary practice location
200 Washington St
Newark, NJ 07102-2921
Mailing address
2 Calais PL
Montville, NJ 07045-9551
Phone (973) 229-4288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA09804900 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington St Pediatrics LLC | Single Specialty | Past | Accepting new patients |
| University Hospital | Past | Accepting new patients | |
| Newark Beth Israel Medical Center Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Newark, NJ
- NPI 1215027966
-
- General Acute Care Hospital
- Newark, NJ
- NPI 1215998323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1639442619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 CALAIS PL",
"city": "MONTVILLE",
"state": "NJ",
"postal_code": "070459551",
"telephone_number": "973-229-4288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WASHINGTON ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071022921",
"telephone_number": "973-622-3890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANNY",
"first_name": "BRYAN",
"middle_name": "ABDUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-21",
"last_updated": "2023-02-23",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA09804900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.