Provider Demographics
NPI:1245647247
Name:REDDY, RAVINDER (DPM)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2545
Mailing Address - Country:US
Mailing Address - Phone:718-960-9000
Mailing Address - Fax:
Practice Address - Street 1:3136 HORIZON RD STE 120
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7808
Practice Address - Country:US
Practice Address - Phone:972-412-1347
Practice Address - Fax:972-463-1185
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP89395213ES0131X
TX2242213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery