Provider Demographics
NPI:1629574348
Name:RAMNARAYAN, VIRESH (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRESH
Middle Name:
Last Name:RAMNARAYAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E TREMONT AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5658
Mailing Address - Country:US
Mailing Address - Phone:347-449-8309
Mailing Address - Fax:
Practice Address - Street 1:1970 E TREMONT AVE APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5658
Practice Address - Country:US
Practice Address - Phone:347-449-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021962363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021962OtherPA LICENSE NUMBER