Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 125628 | NY |
NPI | 1083709794 |
---|---|
Provider Name | Dr. Tharakaram Ravishankar |
First Address | Glen Head, NY 11545-1593 |
Second Address | Glen Head, NY 11545-1593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/07/2010 |