Healthcare Provider Details

I. General information

NPI: 1619391604
Provider Name (Legal Business Name): DR. RAVI MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6852 FRESH POND RD
RIDGEWOOD NY
11385-5230
US

IV. Provider business mailing address

6852 FRESH POND RD
RIDGEWOOD NY
11385-5230
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-6070
  • Fax: 718-497-3126
Mailing address:
  • Phone: 718-497-6070
  • Fax: 718-497-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BALA RAVI
Title or Position: OWNER
Credential: MD
Phone: 718-497-6070