Provider Demographics
NPI:1689782948
Name:ARJUN MEDICAL GROUP PC
Entity Type:Organization
Organization Name:ARJUN MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:PAPANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVICHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-685-2058
Mailing Address - Street 1:120 E 36TH ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-685-2058
Mailing Address - Fax:212-685-2811
Practice Address - Street 1:120 E 36TH ST
Practice Address - Street 2:STE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-685-2058
Practice Address - Fax:212-685-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776883Medicaid
P1120559OtherOXFORD INSURANCE
P1120559OtherOXFORD INSURANCE
NY01776883Medicaid