Provider Demographics
NPI:1750025482
Name:RAVI SUTARIA MD PC
Entity Type:Organization
Organization Name:RAVI SUTARIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:BHUPATLAL
Authorized Official - Last Name:SUTARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-960-7501
Mailing Address - Street 1:11203 QUEENS BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11203 QUEENS BLVD STE 209
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5550
Practice Address - Country:US
Practice Address - Phone:718-515-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty