Healthcare Provider Details

I. General information

NPI: 1487699633
Provider Name (Legal Business Name): RAVI BALIGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 KOCH AVE GREYSTONE PARK PSYCHIATRIC HOSPITAL
MORRIS PLAINS NJ
07950-4400
US

IV. Provider business mailing address

18 SPARROW RD
RANDOLPH NJ
07869-2129
US

V. Phone/Fax

Practice location:
  • Phone: 973-538-1800
  • Fax:
Mailing address:
  • Phone: 973-300-4110
  • Fax: 973-579-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA03046500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: