Provider Demographics
NPI:1275818668
Name:SIMA RAGUTHU MD PLLC
Entity Type:Organization
Organization Name:SIMA RAGUTHU MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMHACHALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-816-1583
Mailing Address - Street 1:38 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4312
Mailing Address - Country:US
Mailing Address - Phone:718-816-1583
Mailing Address - Fax:
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4401
Practice Address - Country:US
Practice Address - Phone:718-816-1583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1413232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11961Medicare UPIN