Healthcare Provider Details

I. General information

NPI: 1629279633
Provider Name (Legal Business Name): AMI RAVAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 TARGEE ST
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

1099 TARGEE ST
STATEN ISLAND NY
10304-4310
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-3210
  • Fax: 718-984-2642
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-984-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number267265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: