Provider Demographics
NPI:1376526673
Name:RAVAL, SUMUL N (MD)
Entity type:Individual
Prefix:DR
First Name:SUMUL
Middle Name:N
Last Name:RAVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 HWY 36
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1462
Mailing Address - Country:US
Mailing Address - Phone:732-229-6200
Mailing Address - Fax:732-229-6201
Practice Address - Street 1:100 HWY 36
Practice Address - Street 2:SUITE 1A
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1462
Practice Address - Country:US
Practice Address - Phone:732-229-6200
Practice Address - Fax:732-229-6201
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-04-12
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA071837002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006394Medicaid
NJ0006394Medicaid
NJH74667Medicare UPIN