Healthcare Provider Details

I. General information

NPI: 1932028032
Provider Name (Legal Business Name): SURESH RANABHAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MYRTLE AVE
BROOKLYN NY
11237-4512
US

IV. Provider business mailing address

25671 AMERICA SQ
CHANTILLY VA
20152-6501
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7708
  • Fax:
Mailing address:
  • Phone: 227-280-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP143968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: