Individual provider Active NPI

Gilad Mizrahi Ghanbari, DO

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Worcester, MA
National Provider Identifier
1649733254
Registry record updated Aug 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
080683 Issued in CT
Practice address
555 Plantation St # 559
Worcester, MA 01605-2376
Phone
(872) 231-3162
Fax
(702) 977-1496
NPI assigned
Apr 10, 2019
Last updated
Aug 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 1026572 MA
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X OP61079628 WA
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 080683 CT Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 307681 NY

Addresses

Primary practice location

555 Plantation St # 559
Worcester, MA 01605-2376

Mailing address

PO Box 22239
New York, NY 10087-0001
Phone (201) 654-6397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260417000645 CT Practitioner - Physical Medicine and Rehabilitation 3476955444 Practice locations: East Lyme, CT

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Touro Un Col of Osteopathic Medicine, New York, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

East Lyme, CT 06333
Phone (312) 888-1831

32 Upper Pattagansett Rd
Unit 21
East Lyme, CT 06333-1147

32 Upper Pattagansett Rd Unit
Suite 21
East Lyme, CT 06333-1149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OP61079628WAMDGeneral Practice Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786752000000",
    "number": "1649733254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22239",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100870001",
            "telephone_number": "201-654-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 PLANTATION ST # 559",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052376",
            "telephone_number": "872-231-3162",
            "fax_number": "702-977-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANBARI",
        "first_name": "GILAD",
        "middle_name": "MIZRAHI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2026-08-15",
        "certification_date": "2026-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MA",
            "license": "1026572",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "WA",
            "license": "OP61079628",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CT",
            "license": "080683",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "307681",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.