Healthcare Provider Details

I. General information

NPI: 1215200076
Provider Name (Legal Business Name): RAVI LOONA MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21135 34TH RD
BAYSIDE NY
11361-1512
US

IV. Provider business mailing address

21135 34TH RD
BAYSIDE NY
11361-1512
US

V. Phone/Fax

Practice location:
  • Phone: 718-229-2503
  • Fax: 718-229-2336
Mailing address:
  • Phone: 718-229-2503
  • Fax: 718-229-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number134105
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. RAVI LOONA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-229-2503