Provider Demographics
NPI:1336145358
Name:RATNATHICAM, WIJAYAN (MD)
Entity Type:Individual
Prefix:
First Name:WIJAYAN
Middle Name:
Last Name:RATNATHICAM
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 1:1985 CROMPOND RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4146
Mailing Address - Country:US
Mailing Address - Phone:914-736-0050
Mailing Address - Fax:914-736-2635
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:BLDG A
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-736-0050
Practice Address - Fax:914-736-2635
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130531208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18A441Medicare ID - Type Unspecified