Healthcare Provider Details

I. General information

NPI: 1104816685
Provider Name (Legal Business Name): PRETAM GANESH RAMPERSAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 86TH ST
BROOKLYN NY
11228-3232
US

IV. Provider business mailing address

301 BUEL AVE SIDE ENTRANCE
STATEN ISLAND NY
10305-2201
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-9898
  • Fax: 718-980-9897
Mailing address:
  • Phone: 718-980-9898
  • Fax: 718-980-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number60210256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: