Provider Demographics
NPI:1457630766
Name:RAWANA, EZEKIEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:DAVID
Last Name:RAWANA
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:P.O BOX 180639
Mailing Address - Street 2:122-01 JAMAICA AVENUE
Mailing Address - City:RICHMOND HILL NORTH
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:860-794-6883
Mailing Address - Fax:
Practice Address - Street 1:363 ZION ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3034
Practice Address - Country:US
Practice Address - Phone:860-794-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259835-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine