Provider Demographics
NPI:1568625192
Name:RAGUSA, NIKOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLA
Middle Name:
Last Name:RAGUSA
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 1:1625 SAINT PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3000
Mailing Address - Country:US
Mailing Address - Phone:718-823-9227
Mailing Address - Fax:718-823-3279
Practice Address - Street 1:1625 SAINT PETERS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3000
Practice Address - Country:US
Practice Address - Phone:718-823-9227
Practice Address - Fax:718-823-3279
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245591207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03232446Medicaid
NY03232446Medicaid