Doctor Name: | INDIRA RAVISHANKAR |
NPI Number: | 1962441873 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MA3665600 |
Business Practice Address: | 169 Minnisink Rd Totowa, NJ - 075121803 |
Business Phone Number: | 9732561700 |
Business Fax Number: | 9738904574 |
Mailing Address: | 5 Geiger Ln, WARREN |
State: | NJ |
Postal Code: | 070595639 |
Phone Number: | 7324690241 |
Fax Number: | 9738904574 |
NPI Enumeration Date: | 06/06/2006 |
NPI Last Update Date: | 01/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MA3665600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |