Healthcare Provider Details

I. General information

NPI: 1790765576
Provider Name (Legal Business Name): KOVIL RAMASAMY M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 AVENUE E SUITE 1A
BAYONNE NJ
07002-3915
US

IV. Provider business mailing address

534 AVENUE E SUITE 1-A
BAYONNE NJ
07002-3987
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-8444
  • Fax: 201-858-4260
Mailing address:
  • Phone: 201-858-8444
  • Fax: 201-858-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA06946500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA06946500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: