Provider Demographics
NPI:1134472400
Name:BUDDHARAJU, RAVI VARMA
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:VARMA
Last Name:BUDDHARAJU
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 1:10 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1213
Mailing Address - Country:US
Mailing Address - Phone:914-319-7666
Mailing Address - Fax:
Practice Address - Street 1:10 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1213
Practice Address - Country:US
Practice Address - Phone:914-319-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist