Provider Demographics
NPI:1689813636
Name:RAVINDRA BHACHAWAT MEDICINE PC
Entity Type:Organization
Organization Name:RAVINDRA BHACHAWAT MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHACHAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-465-9333
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-0852
Mailing Address - Country:US
Mailing Address - Phone:631-465-9333
Mailing Address - Fax:631-465-9336
Practice Address - Street 1:7 WOODBURY FARMS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1242
Practice Address - Country:US
Practice Address - Phone:631-465-9333
Practice Address - Fax:631-465-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2463002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427244276OtherNPI INDIVIDUAL