Basic Information
Provider Information
NPI: 1003010406
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMASWAMY
FirstName: RAVISHANKAR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD, MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUSTAVE L LEVY PL
Address2: BOX 1070
City: NEW YORK
State: NY
PostalCode: 100296500
CountryCode: US
TelephoneNumber: 2126598552
FaxNumber: 2128609737
Practice Location
Address1: 1440 MADISON AVENUE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296500
CountryCode: US
TelephoneNumber: 2126598552
FaxNumber: 2128609737
Other Information
ProviderEnumerationDate: 06/12/2007
LastUpdateDate: 10/27/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300X275411NYY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
207RG0300X004036-1NYN Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

ID Information
IDTypeStateIssuerDescription
0347409505NY MEDICAID


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