1558820977 NPI number — RAVI S. PARIKH MDPC

Table of content: MICHAEL D VAN ANROOY MD (NPI 1598748360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558820977 NPI number — RAVI S. PARIKH MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAVI S. PARIKH MDPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1558820977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 N 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08904-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-545-0094
Provider Business Mailing Address Fax Number:
732-294-9794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 E 78TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10075-0273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-545-0094
Provider Business Practice Location Address Fax Number:
732-294-9794
Provider Enumeration Date:
03/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
732-431-3382

Provider Taxonomy Codes

  • Taxonomy code: 207WX0107X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013331404 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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