Provider Demographics
NPI:1609066901
Name:SIDHU, RAVINDERPAL S (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDERPAL
Middle Name:S
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAVINDER
Other - Middle Name:PAUL
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0809
Mailing Address - Country:US
Mailing Address - Phone:800-345-0064
Mailing Address - Fax:973-251-1086
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:@ ST. PETER'S HOSPITAL ER DEPT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:510-209-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245515207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900585Medicaid