Healthcare Provider Details

I. General information

NPI: 1821799578
Provider Name (Legal Business Name): RAVI SUTARIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11203 QUEENS BLVD STE 209
FOREST HILLS NY
11375-5550
US

IV. Provider business mailing address

20 CARRIAGE CT
SYOSSET NY
11791-3045
US

V. Phone/Fax

Practice location:
  • Phone: 347-960-7501
  • Fax: 347-960-7402
Mailing address:
  • Phone: 347-960-7501
  • Fax: 347-960-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: RAVI BHUPATLAL SUTARIA
Title or Position: PRESIDENT
Credential: MD
Phone: 347-960-7501