Healthcare Provider Details

I. General information

NPI: 1003010406
Provider Name (Legal Business Name): RAVISHANKAR RAMASWAMY MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 MADISON AVENUE
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1070
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8552
  • Fax: 212-860-9737
Mailing address:
  • Phone: 212-659-8552
  • Fax: 212-860-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number004036-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number275411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: