Provider Demographics
NPI:1639449002
Name:RALPH EDWARD BOWMAN, PHYSICIAN PC
Entity Type:Organization
Organization Name:RALPH EDWARD BOWMAN, PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUCKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-856-3323
Mailing Address - Street 1:170 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2220
Mailing Address - Country:US
Mailing Address - Phone:845-856-3323
Mailing Address - Fax:845-856-6107
Practice Address - Street 1:170 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2220
Practice Address - Country:US
Practice Address - Phone:845-856-3323
Practice Address - Fax:845-856-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167733208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01035116Medicaid
NY01035116Medicaid
NYA60184Medicare UPIN