Healthcare Provider Details

I. General information

NPI: 1750441069
Provider Name (Legal Business Name): SUNDARAM RAVIKUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 ASHFORD AVE
DOBBS FERRY NY
10522-1812
US

IV. Provider business mailing address

265 HARDSCRABBLE RD
BRIARCLIFF MANOR NY
10510-1802
US

V. Phone/Fax

Practice location:
  • Phone: 914-591-8400
  • Fax: 914-591-7367
Mailing address:
  • Phone: 914-591-8400
  • Fax: 914-591-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number151069
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: