Provider Demographics
NPI:1407810948
Name:DESAI, RAVI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KUMAR
Last Name:DESAI
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 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:17 LIMESTONE DR
Practice Address - Street 2:STE 3
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8600
Practice Address - Country:US
Practice Address - Phone:716-827-1616
Practice Address - Fax:716-692-4342
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526060005OtherBC/BS
NY02082997Medicaid
NY04110332OtherIHA
NY04110332OtherIHA