1750445771 NPI number — SUMAN CHANDRA RAVURI, MD

Table of content: (NPI 1750445771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750445771 NPI number — SUMAN CHANDRA RAVURI, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMAN CHANDRA RAVURI, MD
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:
1750445771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 N 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-288-8203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 SCHENECTADY AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-604-5402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMEED
Authorized Official First Name:
IMRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
718-604-5469

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  239313 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 239313 . This is a "NEW YORK LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 043990 . This is a "CONNECTICUT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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