Healthcare Provider Details

I. General information

NPI: 1821230699
Provider Name (Legal Business Name): S. RAMACHANDRAN NAIR, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RALPH PLACE STE 211
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

51 NIXON AVENUE
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-727-0707
  • Fax: 718-556-3640
Mailing address:
  • Phone: 718-727-0707
  • Fax: 718-556-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number131614
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number131614
License Number StateNY

VIII. Authorized Official

Name: S. RAMACHANDRAN NAIR
Title or Position: PRESIDENT
Credential: MD, PC
Phone: 718-727-0707