Basic Information
| Provider Information | |||||||||
| NPI: | 1689601395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | REY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | CB-2041 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065048900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884748 | ||||||||
| FaxNumber: | 2036884740 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 YORK ST # CB-2041 | ||||||||
| Address2: | YNH MEDICAL SERVICES PC | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884748 | ||||||||
| FaxNumber: | 2036884740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/01/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 041818 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 041818 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 041818 | CT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2V6703 | 01 | CT | HEALTHNET/COMMERCIAL | OTHER | PENDING | 01 | CT | RR MEDICARE | OTHER | 041818 | 01 | CT | PHYSICIAN LICENSE NUMBER | OTHER | 041818 | 01 | CT | CONNECTICARE | OTHER | 973045 | 01 | CT | USA | OTHER | 25-37092 | 01 | CT | UHC | OTHER | 3820817/7446674 | 01 | CT | AETNA | OTHER | 25-37092 | 01 | CT | AMERICHOICE | OTHER | 001418187 | 05 | CO | MEDICAID | BR8710293 | 01 | CT | FED DEA REGISTRATION | OTHER | P3599592 | 01 | CT | OXFORD | OTHER | 36433 | 01 | CT | CONTROLLED SUBSTANCE NO | OTHER | 010041818CT02 | 01 | CT | ANTHEM BCBS CT | OTHER | 295051 | 01 | CT | WELLCARE | OTHER |