Provider Demographics
NPI:1790765576
Name:RAMASAMY, KOVIL (MD,)
Entity Type:Individual
Prefix:DR
First Name:KOVIL
Middle Name:
Last Name:RAMASAMY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 AVENUE E
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3987
Mailing Address - Country:US
Mailing Address - Phone:201-858-8444
Mailing Address - Fax:201-858-4260
Practice Address - Street 1:534 AVENUE E
Practice Address - Street 2:SUITE 1A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3915
Practice Address - Country:US
Practice Address - Phone:201-858-8444
Practice Address - Fax:201-858-4260
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06946500207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7556778OtherAETNA
NJP00130354OtherRAILROAD MEDICARE
NJ7977301Medicaid
NJ8171455OtherCIGNA
NJ2618801OtherUNITED HEALTHCARE
NJP00130354OtherRAILROAD MEDICARE
NJ7977301Medicaid