Provider Demographics
NPI:1104845411
Name:KUMAR, RAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-264-2424
Mailing Address - Fax:631-264-7881
Practice Address - Street 1:137 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-264-2424
Practice Address - Fax:631-264-7881
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207919-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831992Medicaid
NY96Z2110Medicare ID - Type Unspecified
NY01831992Medicaid