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General NPI Number Information
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NPI Number | 1013031533
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Entity Type | Organization
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Legal Business Name | RAVEENA MEDICAL PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1575 HILLSIDE AVENUE # 103 SUITE #103
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2501
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Country | US
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Telephone | 516-352-1804
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Fax | 516-352-1449
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Provider Business Mailing Address
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Address Line | 9308 QUEENS BLVD # 1B1C
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City | REGO PARK
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State | NY
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Zip | 11374-1135
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Country | US
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Telephone | 718-806-1434
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Fax | 718-806-1435
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Authorized Official
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Title or Position | PRESIDENT
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Name | TEEKARAM PERSAUD
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Credential | MD
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Telephone | 718-806-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 223596
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License Number State | NY
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