Provider Demographics
NPI:1659451557
Name:RAVAL, PAURAVI N (DPM MS)
Entity Type:Individual
Prefix:DR
First Name:PAURAVI
Middle Name:N
Last Name:RAVAL
Suffix:
Gender:F
Credentials:DPM MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1755
Mailing Address - Country:US
Mailing Address - Phone:201-251-0911
Mailing Address - Fax:201-251-7788
Practice Address - Street 1:36 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1755
Practice Address - Country:US
Practice Address - Phone:201-251-0911
Practice Address - Fax:201-251-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001953213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5160006Medicaid
NJ5160006Medicaid
NJU02017Medicare PIN