1376824177 NPI number — MR. SUJIT KUMAR RAVAL RPH

Table of content: MR. SUJIT KUMAR RAVAL RPH (NPI 1376824177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376824177 NPI number — MR. SUJIT KUMAR RAVAL RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVAL
Provider First Name:
SUJIT
Provider Middle Name:
KUMAR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376824177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11706 BELLA MILANO CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-6059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-297-8514
Provider Business Mailing Address Fax Number:
407-859-6442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7003 PRESIDENTS DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-859-6197
Provider Business Practice Location Address Fax Number:
407-859-6442
Provider Enumeration Date:
09/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS32157 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)