Provider Demographics
NPI:1053464503
Name:BHULLAR, RAVNEET KAUR (MD)
Entity Type:Individual
Prefix:MRS
First Name:RAVNEET
Middle Name:KAUR
Last Name:BHULLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:RAVNEET
Other - Middle Name:KAUR
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-439-4326
Mailing Address - Fax:518-439-5962
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-439-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRT 1653207R00000X
NY266362207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400085383Medicare PIN