Healthcare Provider Details

I. General information

NPI: 1699271106
Provider Name (Legal Business Name): RAVI JARIWALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 52ND ST
NEW YORK NY
10019-6239
US

IV. Provider business mailing address

1 PARK AVE FL 11
NEW YORK NY
10016-5818
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2100
  • Fax: 646-754-2148
Mailing address:
  • Phone: 646-501-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number329501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: