Provider Demographics
NPI:1558531871
Name:JAGWANI, RAVEENA SHARMA
Entity Type:Individual
Prefix:
First Name:RAVEENA
Middle Name:SHARMA
Last Name:JAGWANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:(33RD FLOOR)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:212-751-1333
Mailing Address - Fax:212-751-1410
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:(33RD FLOOR)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-751-1333
Practice Address - Fax:212-751-1410
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050277-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist