Provider Demographics
NPI:1437406642
Name:GINJALA, RAVINDRA KUMAR (PT)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:KUMAR
Last Name:GINJALA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4230
Mailing Address - Country:US
Mailing Address - Phone:718-321-9688
Mailing Address - Fax:718-321-9668
Practice Address - Street 1:4211 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4230
Practice Address - Country:US
Practice Address - Phone:718-321-9688
Practice Address - Fax:718-321-9668
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist