Healthcare Provider Details

I. General information

NPI: 1336145358
Provider Name (Legal Business Name): WIJAYAN RATNATHICAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 CROMPOND RD BLDG A
CORTLANDT MANOR NY
10567-4146
US

IV. Provider business mailing address

1985 CROMPOND RD BLDG A
CORTLANDT MANOR NY
10567-4146
US

V. Phone/Fax

Practice location:
  • Phone: 914-736-0050
  • Fax: 914-736-2635
Mailing address:
  • Phone: 914-736-0050
  • Fax: 914-736-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number130531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: