Provider Demographics
NPI:1336511351
Name:PRETAM G RAMPERSAUD MD PC
Entity Type:Organization
Organization Name:PRETAM G RAMPERSAUD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRETMAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAMPERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-979-9790
Mailing Address - Street 1:774 DUMONT PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3122
Mailing Address - Country:US
Mailing Address - Phone:718-979-9790
Mailing Address - Fax:718-979-9798
Practice Address - Street 1:457 ALTER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2310
Practice Address - Country:US
Practice Address - Phone:718-979-9790
Practice Address - Fax:718-979-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210256207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100134101Medicare PIN