Provider Demographics
NPI:1851815617
Name:RAMANATHAN, ANANTHA KUMARASAMY
Entity Type:Individual
Prefix:
First Name:ANANTHA
Middle Name:KUMARASAMY
Last Name:RAMANATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 165TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3513
Mailing Address - Country:US
Mailing Address - Phone:929-365-7501
Mailing Address - Fax:
Practice Address - Street 1:2201 HEMPSTEAD TPKE, NASSAU UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1859
Practice Address - Country:US
Practice Address - Phone:516-572-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2906082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery