Healthcare Provider Details

I. General information

NPI: 1104345107
Provider Name (Legal Business Name): SHIV RAMLOCHAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY DRIVE
KINGSTON NY
12401
US

IV. Provider business mailing address

2400 RABBETOY ST
SCHENECTADY NY
12303-4114
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-6400
  • Fax:
Mailing address:
  • Phone: 518-878-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number325068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: