Provider Demographics
NPI:1174505630
Name:KAMBLE, RAVI KAIZER (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KAIZER
Last Name:KAMBLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2346
Mailing Address - Country:US
Mailing Address - Phone:718-979-1333
Mailing Address - Fax:718-351-3215
Practice Address - Street 1:2338 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2346
Practice Address - Country:US
Practice Address - Phone:718-979-1333
Practice Address - Fax:718-351-3215
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005931213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400052432Medicare PIN
NYU95308Medicare UPIN
NYPH5937Z251Medicare ID - Type UnspecifiedPROVIDER ID NUMBER (PIN)