Provider Demographics
NPI:1457508293
Name:TADUVAI, RAMESH
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:TADUVAI
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 1:449 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4210
Mailing Address - Country:US
Mailing Address - Phone:212-665-6007
Mailing Address - Fax:212-665-6220
Practice Address - Street 1:449 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4210
Practice Address - Country:US
Practice Address - Phone:212-665-6007
Practice Address - Fax:212-665-6220
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590265Medicaid
NY02590265Medicaid