Provider Demographics
NPI:1457575201
Name:BAKHSHOUDEH, RAMAK (PT)
Entity Type:Individual
Prefix:
First Name:RAMAK
Middle Name:
Last Name:BAKHSHOUDEH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3805
Mailing Address - Country:US
Mailing Address - Phone:631-273-1300
Mailing Address - Fax:631-851-3865
Practice Address - Street 1:120 PLANT AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3805
Practice Address - Country:US
Practice Address - Phone:631-273-1300
Practice Address - Fax:631-851-3865
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015236-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6698072OtherGHI
NY141864POtherHIP
NYQ03D51OtherBCBS
NYQ03D51OtherBCBS
NY6698072OtherGHI