Provider Demographics
NPI:1013410968
Name:RAMACHANDRAN, SIVASWAMY
Entity Type:Individual
Prefix:MR
First Name:SIVASWAMY
Middle Name:
Last Name:RAMACHANDRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4715
Mailing Address - Country:US
Mailing Address - Phone:917-921-6291
Mailing Address - Fax:
Practice Address - Street 1:285 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1906
Practice Address - Country:US
Practice Address - Phone:718-442-8588
Practice Address - Fax:718-442-6737
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009358225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant