Provider Demographics
NPI:1518365782
Name:G.K. RAMAN DDS,FAGD
Entity Type:Organization
Organization Name:G.K. RAMAN DDS,FAGD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPALSWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALYANARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-789-6300
Mailing Address - Street 1:361 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4103
Mailing Address - Country:US
Mailing Address - Phone:718-789-6300
Mailing Address - Fax:718-789-6785
Practice Address - Street 1:361 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4103
Practice Address - Country:US
Practice Address - Phone:718-789-6300
Practice Address - Fax:718-789-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034553305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00408342Medicaid