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General NPI Number Information
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NPI Number | 1003721788
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Entity Type | Individual
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Provider Name | VIJAY RAMANATHAN LAC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 10302 ROCKAWAY BEACH BLVD # 1A
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2796
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Country | US
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Telephone | 646-769-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 10302 ROCKAWAY BEACH BLVD # 1A
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2796
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Country | US
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Telephone | 646-769-0857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00828700
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License Number State | NJ
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