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General NPI Number Information
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NPI Number | 1669001764
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Entity Type | Individual
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Provider Name | ANDREW BRENT RAVIN DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 8040 COOPER AVE STE 4202
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City | GLENDALE
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State | NY
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Zip | 11385-7726
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Country | US
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Telephone | 718-887-3090
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Fax | 718-326-2656
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Provider Business Mailing Address
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Address Line | 11 VERONICA CT
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City | SMITHTOWN
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State | NY
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Zip | 11787-1323
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Country | US
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Telephone | 631-682-4880
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 335488
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License Number State | NY
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