Provider Demographics
NPI:1508887324
Name:RAGUTHU, SIMA (MD, PLLC)
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:
Last Name:RAGUTHU
Suffix:
Gender:F
Credentials:MD, PLLC
Other - Prefix:
Other - First Name:SIMHACHALAM
Other - Middle Name:
Other - Last Name:RAGUTHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:38 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-816-1583
Mailing Address - Fax:718-815-5388
Practice Address - Street 1:11 RALPH PLACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-816-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1413232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00733073Medicaid
NY00733073Medicaid
NY70A481Medicare ID - Type Unspecified