Provider Demographics
NPI:1538847587
Name:GHANTOUS, EIHAB (MD)
Entity type:Individual
Prefix:DR
First Name:EIHAB
Middle Name:
Last Name:GHANTOUS
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 1:530 1ST AVE FL HCC5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-4300
Mailing Address - Fax:212-263-4310
Practice Address - Street 1:530 1ST AVE FL HCC5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-4300
Practice Address - Fax:212-263-4310
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2025-07-29
Deactivation Date:2024-02-16
Deactivation Code:
Reactivation Date:2024-04-04
Provider Licenses
StateLicense IDTaxonomies
NY334732207RC0000X, 207RA0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program