Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 203725 | NY |
NPI | 1003874405 |
---|---|
Provider Name | Dr. Bala Krishna Babji Ravi |
First Address | Brooklyn, NY 11237-4006 |
Second Address | Brooklyn, NY 11237-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01668097 | (05) | NY |
G34489 | (02) | NM |