Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005931 | NY |
NPI | 1174505630 |
---|---|
Provider Name | Dr. Ravi Kaizer Kamble |
First Address | Staten Island, NY 10306-2346 |
Second Address | Staten Island, NY 10306-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 13/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95308 | (02) | NY |