Provider Demographics
NPI:1215200076
Name:RAVI LOONA MDPC
Entity Type:Organization
Organization Name:RAVI LOONA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-229-2503
Mailing Address - Street 1:21135 34TH RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1512
Mailing Address - Country:US
Mailing Address - Phone:718-229-2503
Mailing Address - Fax:718-229-2336
Practice Address - Street 1:21135 34TH RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1512
Practice Address - Country:US
Practice Address - Phone:718-229-2503
Practice Address - Fax:718-229-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134105207X00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty