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General NPI Number Information
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NPI Number | 1790276780
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Entity Type | Individual
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Provider Name | NILESH KAUSHIK RAVAL MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 700 WHITE PLAINS RD STE 309
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City | SCARSDALE
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State | NY
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Zip | 10583-5032
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Country | US
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Telephone | 631-234-5666
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Fax | 631-234-0539
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Provider Business Mailing Address
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Address Line | 200 MOTOR PKWY STE A2
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City | HAUPPAUGE
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State | NY
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Zip | 11788-5112
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Country | US
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Telephone | 631-234-5666
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Fax | 631-234-0539
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4351034422
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 314593
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License Number State | NY
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