Provider Demographics
NPI:1730165614
Name:GHATAN, H. ELIOT Y. (MD)
Entity type:Individual
Prefix:
First Name:H. ELIOT Y.
Middle Name:
Last Name:GHATAN
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 1:1226 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5102
Mailing Address - Country:US
Mailing Address - Phone:718-253-2053
Mailing Address - Fax:718-253-2051
Practice Address - Street 1:1226 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5102
Practice Address - Country:US
Practice Address - Phone:718-253-2053
Practice Address - Fax:718-253-2051
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05849000207NS0135X
NY167403207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE56273Medicare UPIN