MEDICARE: DR. RAMON EMILIO RAVELO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	238816	NY

General Provider Information

NPI Number	:	1437172426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMON EMILIO RAVELO M.D.

Provider Business Mailing Address
First Line	:	2106 LINDEN ST APT 2F
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-2462
Country	:	US
Telephone Number	:	646-401-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 W 185TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-3101
Country	:	US
Telephone Number	:	212-927-7353
Fax Number	:	212-927-6519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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