Provider Demographics
NPI:1750793691
Name:GANESH, LATCHMIN (MS)
Entity type:Individual
Prefix:MRS
First Name:LATCHMIN
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 101ST AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1409
Mailing Address - Country:US
Mailing Address - Phone:917-705-4520
Mailing Address - Fax:
Practice Address - Street 1:12401 101ST AVE FL 3
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1409
Practice Address - Country:US
Practice Address - Phone:917-705-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY822817390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid