Healthcare Provider Details

I. General information

NPI: 1194781013
Provider Name (Legal Business Name): RAVI N RATHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 FRANKLIN ST
JERSEY CITY NJ
07307-2326
US

IV. Provider business mailing address

120 FRANKLIN ST
JERSEY CITY NJ
07307-2326
US

V. Phone/Fax

Practice location:
  • Phone: 201-216-9791
  • Fax: 201-216-1362
Mailing address:
  • Phone: 201-216-9791
  • Fax: 201-216-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06918200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA06918200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: