Provider Demographics
NPI:1245302140
Name:RAGSDALE, EDWARD S (PH,D)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 5TH AVE
Mailing Address - Street 2:APT. 16D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4320
Mailing Address - Country:US
Mailing Address - Phone:212-255-1488
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON SQ W FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1629
Practice Address - Country:US
Practice Address - Phone:212-989-5803
Practice Address - Fax:212-243-4511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9211-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV68471Medicare ID - Type UnspecifiedPSYCHOLOGIST