Provider Demographics
NPI:1578913794
Name:RAMPERSAUD, MALA S
Entity Type:Individual
Prefix:MS
First Name:MALA
Middle Name:S
Last Name:RAMPERSAUD
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 1:12003 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3242
Mailing Address - Country:US
Mailing Address - Phone:516-476-6034
Mailing Address - Fax:
Practice Address - Street 1:12003 133RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3242
Practice Address - Country:US
Practice Address - Phone:516-476-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist